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INSANITY  AND  INSANE  ASYLUMS. 


REPORT  OF  E.  T.  WILKINS,  M.  B., 

COMMISSIONER   IN   LUNACY 

FOE  THE  STATE  OF  CALIFOENIA, 


MADE      TO 


HIS  EXCELLENCY  K.  H.   HAIGHT,  GOVERNOR, 
December   9d,  1871. 


t^"" 


T.  A.  SPRIXGER STATE  PRINTER. 


COjSTTEISrTS. 


CHAPTEE   I. 


INTRODUCTORY. 


Powers,  Duties,  and  Appointment  of  Commissioner— Importance  of  the  Commis- 
sion—Asylums Visited— i^  umber  of  Patients  in  Asylums  Visited- Other  Insti- 
tutions Visited— Plans  of  Asylums— Statistical  Tables— Meetings  of  Superintend- 
ents Attended— Importance  of  such  Meetings— Books  Obtained  for  the  State 
Library — Sources  of  Information — Acknowledgments 


CHAPTEE    II. 

IXSAXITY   A   DISEASE   OF   THE   BRAIN. 

VTliat  is  Insanity? 

CHAPTEE     III. 

INSANITY   AS   IT   NOW   EXISTS. 

The  Subject  Generally — Insanity  in  England — In  Scotland — In  Ireland — In  France — 
In  Italy— In  Prussia— In  Austria— In  German  States— In  Bavaria— In  Switzer- 
land—In Belgium- In  Holland— In  Denmark— In  Sweden— In  Xorway— In  New 
South  "Wales— In  the  United  States — In  California 


CHAPTEE     IV. 

CAUSES  or  INSANITY— SOME  OF  THE  INFLUENCES  OPERATING  IN  ITS  DEVELOFMENT. 

General  Observations — Assigned  Causes— Physical  Causes— Moral  Causes— Observa- 
tions upon  Assigned  Causes — Principal  Assigned  Causes — Insanity  Found  in  all 
Countries— Enumeration  of  the  Insane— Tables  Eelating  to  Enumeration— Enu- 
merations Imperfect— Difficulties  in  the  way  of  a  Perfect  Enumeration— Influence 
of  Age— Influence  of  Age  in  the  Different  Paces- Influence  of  Sex— Influence 
of  Marriage 32 

CHAPTEE   Y. 

INFLUENCE   OF   SOCIAL   DISTINCTIONS. 

Diseases  of  the  Brain  Peculiar  to  no  Class  in  Society 49 


IV 


CHAPTEE     YI. 

APPAEEXT   IXCEEASE   OF   I^SAXITY. 

Increase  of  Insanity  Demonstrated 5-4 

CHAPTEE   Til. 

IXSAXITT   IX   FKAXCE. 

General  Statistics  of  the  Insane  from  1854  to  1866 — Doctor  Motet's  Analysis  of  Le- 

goyt's  Work 66 

CHAPTEE  Till. 

rS'SAXITY   AMCXG   THE   AXCIEXTS. 

In  the  time  of  the  Ancients — In  the  Middle  Ages — In  the  Eighteenth  and  Xine- 
teenth  Centuries — In  England — In  France — In  Eome — In  the  Germanic  Con- 
federation— Ohservations  upon  Eoregoing  Subjects — Cruel  Treatment  the  Eesuit 
of  Ignorance — Xew  York  Poor  Houses — Amelioration  in  the  Treatment  of  the 
Insane  as  compared  with  Former  Periods — Proof  of  the  Advantages  of  Moral 
Treatment 86 

CHAPTEE     IX. 

IXSAXE   ASYLUMS,   LOCATIOX,    SIZE,    SITES,    ETC. 

Location — Influence  that  Distance  ought  to  have  on  Location — Effect  of  Multi- 
plying Hospitals— Effects  of  Kailroads  and  other  Facilities  of  Travel — Hospitals 
Better  Known  to  Xeighhoring  People — Observations  on  Foregoing  Topics — Xew 
York  State  Lunatic  Asylums — General  Suggestions — Propositions  relative  to  the 
Stnicture  and  Arrangements  for  American  Institutions  for  the  Insane — English 
Lunacy  Commissioners  on  Sites,  Construction,  Size,  etc. — Suggestions  of  the 
Scotch  Board — Size  of  Hospitals — Quantity  of  Land  Xecessary — Comments  upon 
Kirkbride's  Views lOS 

CHAPTEE  X. 

IXSAXE   ASYLUMS— DOCTOR    MAXXIXG's   EEPORT. 

Synopsis  of  Doctor  Manning's  Eeport— Comments  upon  the  same..... lU 

CHAPTEE  XL 

CRIMINAL   IXSAXE. 

An  important  question  connected  with  the  care  of  the  insane  should  not  be  passed  by 

without  notice 161 

CHAPTEE     XII. 

CHROXIC   IXSAXE. 

Provisions  for  Curables  and  Incurables  in  Separate  Institutions 164 


CHAPTER    XIII. 

TREATMENT   OF   INSANITY. 

Treatment  in  English  As3'lum?—J/«»?'a—Epilep^^y  connected  with  Insanity— Paraly- 
sis connected  with  Insanity— Melancholia— Observations  on  present  Treatment  of 
Insanity- I'^o 

CHAPTER     XIY. 

INSANITY  IN    GENERAL. 

Increased  attention  to  Insanit}^— Growth  of  Hospitals  in  United  States— Increase  of 
Hospitals  in  United  States — Increased  Accommodation — Hospitals  exhibit  Insan- 
ity—IS'on-residents-Should  other  States  send  their  Insane  to  California— Insanity 
in  other  States— Kesults  of  Treatment— Curability  of  the  Insane— Etfects  of  Early 
Treatment— Good  Hospitals  necessary  to  Favorable  Ecsults— Eesults  in  our  Asy- 
lum—Doubtful and  Hopeless  Cases— Economy  of  Early  Treatment— Probable 
Duration  of  Life  in  Chronic  Cases— Increase  of  Patients  in  our  Asj^lum— Causes 
tending  to  this  Eesult— Will  the  Children  of  Foreigners  be  as  Liable  to  Insanity 
as  their  Parents— Observations  upon  Physical  and  Moral  Causes  producing  Insan- 
ity—Intemperance  a  Leading  Cause  of  Insanity— Duty  of  State  relative  to  Asy- 
lums—Physicians not  generally  Informed  on  the  Subjectof  Insanity— Psychology 
recommended  to  be  Taught  in  Medical  Schools— Effect  of  the  Liberal  and  of  the 
Economical  Plan  of  Care  and  Treatment l^S 

.    CHAPTER    XY. 

ECONOMY   OF   PROVIDING  AMPLE   CURATIVE   ACCOMMODATIfXN'S. 

The  Economy  of  Eestoration,  and  the  Amount  Saved  the  State  by  the  Cures  already 

Effected  in  our  Asylum ". 218 

CTIAPTEE    XYI. 

PLAN   BEST   ADAPTED   TO  CARE   AND   TREATMENT   OF   THE   INSANE. 


General  Observations— Cottage  System— Farm  Asj^lums- Close  Asylum.-— Pavilion 
Plan 


-;/i*>^ 


900 


APPENDICES 231 


IIS^DEX. 


Pagp. 

Asjium?  visited 2 

Acknowledgements 7 

^Asylum  at  Stockton  overcrowded 136 

^Asylum  at  Stockton  should  be  finished I37 

Asylums.    New  one  needed I37 

-Asylums.    Results  in  California 194 

'  Asylums.    Increase  of  patients  in  ten  years ; 197 

Asylums.    Duty  of  State 212 

Asylums.    Manning's  Report I44 

Attendants 1,S7 

Asylums  in  process  of  erection 190 

Asylums.     Good  ones  necessary  to  favorable  results 194 

As3'lums.    Location,  size,  etc , 108 

Asylums.    Influence  of  distance 109 

Asylums  in  ]S"ew.York 117 

Asylums.    Propositions  relative  to  the  structure 121 

Asylums.     Best  plan 222 

Asj^lums.     Growth  of. 189 

Asylums.     Should  be  in  healthy  locality 138 

Asylums,     Quantity  of  land  necessar}' 138 

Asylums.    Organization  of 142 

Asylums.    Increase  of  in  the  United  States 191 

Asylums.    Better  known  to  the  neighboring  people 115 

Books  obtained  for  State  Library 6 

Cruel  treatment  the  result  of  ignorance 100 

Concluding  remarks 228 

Commissioners 138 

Comments  on  Kirkbride's  views 144 

Construction 152 

Comments  on  Manning's  Report 158 

Criminal  insane 161 

Chronic  insane 164 

Curability  of  insane 202 

Dining  halls 135 

Directors  and  Superintendents 186 

Doubtful  and  hopeless  cases 195 


Till 

Duration  of  insanity .' 196 

Enumeration  of  the  insane *iO 

Enumeration.     Difficulties  of. -iO 

Enumeration  imperfect -iO 

Effect  of  multipl^nng  hospitals 11- 

Effect  of  railroads 115 

English  Lunacy  Commissioners 124 

Economy  of  early  treatment  195 

Effects  of  liberal  treatment -15 

Economy  of  cure -18 

Establishment  of  asylums  in  the  Briti.-^h  Provinces 190 

General  results -95 

Introductory 1 

Importance  of  the  Commission 1 

Insanity  a  disease  of  the  brain 8 

Insanity  as  it  now  exists 8 

Tnsanity  in  England 9 

Jjisanity  in  Scotland 19 

lasanity  in  Ireland 1- 

Insanity  in  Erance H 

Insanity  in  France.    Ztlotet's  Analysis 06 

Insanity  in  Italy 15 

lugeaity  in  Prussia 10 

Insanit3'  in  Austria 1' 

Pnsaraty  in  the  German  States 19 

Insanity  in  Bavaria -9 

Insardtj''  in  Sv/itzeriaud 21 

Insaaity  in  Belgium 22 

Insanitj-  in  Holland 23 

Insanity  in  Denmark  and  Sweden 25 

Insanity  in  Norwaj- 26 

Insanity  in  New  South  Wales 27 

Insanity  in  the  United  States 28 

^"InsanitA- in  California SO 

Insanity-     Causes  and  influences  producing  it 32 

Insanity,    xissigned  causes 32 

InsanitjT.    Observations 31 

Insauitj^    Comparative  view  of  assigned  causes 36 

Influence  of  age -±1 

Influence  of  sex ••• -16 

Influence  of  marriage "1^ 

Influence  of  social  distinction 49 

Insanity.     Apparent  increase  of 54 

Insanity  among  the  Ancients 86 

Insanity  in  the  Middle  Ages 93 

Insanit}'.     Condition  of  in  England 94 

Insanit3^     Condition  of  in  France 97 

Insanit}^     Condition  of  in  Kome  and  Limerick 97 

Insanity  in  the  Germanic  Confederation 98 

Insanity.    Observations *• •••••  99 

Insane  in  New  York  Poorhouses 100 


IX 

Insane.     Amelioration  in  the  treatment  of  insanity .     Re^t!•aiIlt  and  seclusion HHI 

ln.-=anc.     One  to  four  hundred  and  eighty-nine ];{<) 

[ncrea*ed  mortality  in  Stockton i;>7 

Insanity.     Treatment  of. 1^5 

Insanity  in  general IHS 

Tn-ianity.     Duration  of  the  disease UU 

livCormatio!).     S<jurces  of 7 


APPENDICES. 

Aj'pt'ndix  A — 

Statistical  tables  of  United  States 283 

*^Jst  of  Asylums  in  United  States 234 

List  of  Asylums  in  Canada 240 

Appendix  B — 

List  of  Asylums  in  England 247 

List  of  Asylums  in  Scotland 257 

List  of  Asylums  in  Ireland 262 

AppMidix  0 — 

List  of  Asylums  in  Belgium 268 

List  of  Asylums  in  Holland 272 

List  of  Asylums  in  Trance 279 

List  of  Asylums  in  Italy 280 

List  of  A.-^ylums  in  German  States  and  Switzerland 282 

List  of  Asylums  in  Germanic  Confederation 284 

A{»pe-ndix  G— 

Appendix  G 289 

List  of  Asylums  in  France 291 

Appendix  H — 

Opening  of  the  Sussex  Lunatic  Asylum 294 

The  Asj^lum  Bootham,  York 294 

Night  Attendants 29f5 

York  Asylum 298 

Missing  List 299 

Brookwood  Asylum 299 

Complaint  and  Commitment 303 

Physician's  Certificate 303 

Dietary 305 

Eichmond,  near  Dublin 305 

Sussex  County  Asylum.    Diet  scale 30fi 

Edinburgh  Eoyal  Asylum.    Diet  table 307 

Quartres  Mares,  near  Eouen 308 

General  Eules  for  the  Surrey  County  Lunatic  Asylums 309 

Proposed  Case  Book.    (English  Histofy) 318 

State  on  admission  more  fully  arranged 318 

Plans,  etc.,  of  the  Boston  Hospital  for  the  Insane,  at  Winthrop 339 

County  of  Surrey  Additiona]  Lunatic  Asvlum ^^^^^^^^^^^^^^^^^ 


IN^SANITT 


AND 


INSANE      ASYLUMS 


CHAPTEE   I. 
INTKODUCTOKY. 


Powers,  Duties,  and  Appointment  of  Commissioner — Importance  of  the  Commission — 
Asylums  Visited — Number  of  Patients  in  Asylums  Visited — Other  Institutions  Vis- 
ited— Plans  of  Asylums — Statistical  Tables — Meetings  of  Superintendents  Attended — 
Importance  of  such  Meetings — Books  Obtained  for  the  State  Library — Sources  of 
Intbrmation — Acknowledgments. 

POWERS,    DUTIES,    AND    APPOINTMENT    OF    COMMISSIONER. 

An  Act  authorizing  the  appointment  of  a  Commissioner  to  visit  the 
principal  Insane  Asylums  of  the  United  States  and  Europe,  approved 
February  eighteenth,  eighteen  hundred  and  seventy,  directs  the  Com- 
missioner to  visit  such  asylums  as  soon  as  possible,  and  to  collect  and 
compile  all  accessible  and  reliable  information  as  to  their  management, 
the  different  modes  of  treatment,  and  the  statistics  of  insanity,  especial 
attention  being  called  to  the  asylums  of  Great  Britain,  Ireland,  France, 
and  Germany.  He  is  further  directed  to  make  a  written  report  to  the 
Governor,  in  which  he  shall  embody  at  length  a  history  of  the  manage- 
ment adopted  at  such  asylums,  a  statement  of  the  different  modes  of 
treatment  in  use,  and  such  statistics  as  he  may  deem  reliable. 

The  Governor  conferred  the  honor  of  this  appointment  u23on  me,  and 
being  in  entire  accord  with  my  tastes  and  desires,  having  for  a  long 
time  felt  a  deep  interest  in  the  subject  to  be  investigated  and  an  earnest 
sympathy  for  that  class  of  our  fellow  beings  in  whose  behalf  the  inves- 
tigation was  ordered  to  be  made,  I  entered  at  once  upon  the  duties 
assigned  me. 

IMPORTANCE    OF    THE    WORK. 

Appreciating  the  importance  of  the  subject,  and  feeling  that  the  peo- 
ple, and  especially  those  whose  duty  it  is  to  make  our  laws,  protect  our 


citizens,  and  provide  for  the  care  and  maintenance  of  our  unfortunates, 
should  have  all  the  light  that  the  wisdom  and  experience  of  the  learned 
men  in  other  States  and  countries  could  shed  upon  a  subject  about  which 
so  little  is  known  by  the  great  mass  even  of  the  reading  public,  the  work 
was  entered  upon  with  some  misgivings,  but  a  sincere  hope  that  the 
laudable  object  of  the  mission  might  be  crowned  with  success. 

The  law  is  a  comjirehensive  one,  and  opens  a  wide  field  for  interesting 
investigation  and  extensive  research;  one  in  which  many  an  eminent 
man  has  spent  a  lifetime  of  labor  and  of  thought,  which  it  has  been  our 
object  to  search  for,  to  find,  and  to  appropriate. 

We  have  not  gone  forth  with  the  expectation  or  even  the  hope  of 
originating  anything  u2)on  the  subject,  but  rather  to  collect  the  accumu- 
lated truths  gathered  by  the  wisdom  and  experience  of  other  men  in 
other  lands,  that  we  might  bring  them  home  to  California  and  strew 
them  broadcast  before  our  people.  We  did  not  for  a  moment  suppose 
that  a  tithe  of  this  information  could  be  embodied  in  a  rej^ort,  however 
elaborate.  The  diversity  of  subjects  necessarily  touched  upon  would 
render  it  impossible  to  enter  fully  into  the  consideration  of  anj^;  yet  it 
is  hoped  that  the  attention  of  those  who  desire  further  light  on  a  matter 
of  so  much  interest  to  the  State,  the  citizen,  and  the  philanthropist  may 
be  directed  to  the  channel  where  it  exists  in  abundance,  and  where  it 
may  be  found  by  a  little  patient  and  careful  research.  To  all  such, 
therefore,  who  can  find  in  the  accompanying  report  only  a  fragment  of 
what  they  desire  to  know,  let  us  say,  look  to  the  shelves  of  our  State 
Library,  recently  replenished  with  a  liberal  list  of  the  most  valuable 
works  ever  contributed  by  the  mind  of  man  to  the  science  of  psychol- 
ogy, and  you  will  find  nearly  all  that  exists  on  the  important  subject  to 
which  we  desire  to  attract  your  especial  attention. 

Having  spent  a  sufficient  length  of  time  at  Stockton  to  become  thor- 
oughly informed  with  regard  to  the  condition,  construction,  and  require- 
ments of  our  asylum,  its  general  management,  good  features,  and  glaring 
defects,  we  started  out  to  compare  them  with  what  could  be  found  in 
other  States  and  countries.  These  comparisons  have  in  some  respects 
been  in  our  favor,  and,  as  might  naturally  be  expected,  against  us  in 
others — in  what  particulars  we  Vvill  endeavor  to  point  out  in  due  time, 
and  trust,  while  we  commend  our  virtues  to  our  brethren  for  their  adop- 
tion, we  will  with  equal  alacrity  and  liberality  give  up  our  defects  and 
substitute  them  with  some  of  the  excellent  features  of  other  institu- 
tions. 

ASYLUMS    VISITED. 

During  these  investigations,  one  hundred  and  forty-nine  Insane  Asy- 
lums in  complete  working  order  have  been  visited,  making  an  average 
of  two  each  week  during  the  whole  period.  Forty-five  of  these  were 
in  the  United  States,  one  in  Canada,  tiftccn  in  Italy,  three  in  Bavaria, 
seven  in  Austria,  eleven  in  the  German  States,  two  in  Switzerland,  thir- 
teen in  France,  eight  in  Belgium,  three  in  Holland,  twenty-four  in  Eng- 
land, ten  in  Scotland,  and  seven  in  Ireland,  the  names,  locations,  and- 
names  of  the  Superintendents  of  which  will  be  found  in  the  table  fol- 
lowing;: 


Name  of  Asylum. 

Location. 

Name  of  Superintendent. 

Tnited  States: 
Iii^^aiiC  Asylum  of  California 

Stockton,  California 

Alameda,  California 

St.  Louis,  Missouri . 

G.  A  Shurtleff. 

St.  Vincent  

Fulton,  Missouri 

Near  St.  Louis,  Mo 

Williamsburg,  Va 

Staunton    Va    

C.  H.  Huo-hes. 

Charles  A\ .  Stephens. 

T)     1^      Rrnwpr 

T^^.ustpTii    A<vliiin  .  . 

AVe-^tern  As3'luni   

F.  T.  Stribbling. 
D.  B    Conrad 

Near  Kichmond,  Va 

Baltimore,  Maryland ... 
Near  Baltimore 

Mai'vland  Hc^pital    .  ... 

R   F   Stcnnirt 

Mount  Hope  Ketreat 

Eastern  Lunatic  A'^vlum     

William  H.  Stokes 

Lexington,  Kentucky... 

John  AV.  AVhitney. 
James  Rodman. 
J.  H.  Callender. 

Tennessee  Hospital 

North  Carolina  Insane  Asylum 

Ealeio-h 

Eugene  Grissom. 
J.  F.  Ensor. 

Government  A'^ylum     

Near  AVashington,  D.  C 

Charles  C   Nichols 

Pennsylvania  Ho.-pital 

Philadelphia,  Pa 

Insane  Dep't  Philadelphia  Almshouse 
Friends'  Asylum 

Philadelphia.  Pa 

Philadelphia,  Pa 

D.  D.  Richardson. 
J   H.  Vv'^orthino-ton. 

State  Lunatic  Asylum 

Trenton,  New  Jersey ... 

Utica,  New  York  

Flatbush,  Long  Island.. 

Bloomingdale,  N.  Y 

Biackwell's  Island 

Ovid   N  Y 

H.  A.  Buttolph. 

Kings  Count}^  Lunatic  AsA^Ium 

Edw.  R.  Chapin. 
D   Tilden  Brown. 

New  Yoi'k  City  Lunatic  Asylum 

AVillard  As\'lum 

R.  L.  Parsons. 
J.  B.  Chapin. 
George  Cook. 
James  AV.  Wllkie. 

Brigham  Hall 

Canandaigua,  N.  Y 

Auburn,  N.  Y     . 

State  Criminal  Asylum 

General  Hospital  for  the  Insane 

Retreat  for  the  Insane  

Middletown,  Conn 

A.  M.  Shew. 
John  S.  Butler. 

Vermont  Asjdum  for  the  Insane  

]VIaine  Insane  Hospital 

W^illiam  H.  Rockwell. 

Auo^usta  

Henry  M.  Harlow. 

New  Hampshire  Asylum  for  the  In- 
sane   

Butler  Hospital  for  the  Insane  

Providence,  R.  I 

"Worcester,  Mass 

Northampton,  Mass 

Taunton ,  Mass 

Somerville,  Mass 

Boston,  Mass 

John  W.  Sawyer. 
Merrick  Bemis. 
Pliny  Earle. 
William  W.  Godding. 
George  F.  Jelly. 
Clement  A   AValker. 

State  Lunatic  Hospital 

State  Lunatic  Hospital 

State  Lunatic  Hospital  

McLean  Asjdum  lor  the  Insane 

Michigan  Asylum 

E    H   A^an  Beusen 

Mount  Pleasant 

Jacksonville 

Indianapolis 

Longview,  Ohio 

Dayton,  Ohio 

Toronto 

Genoa 

Naples 

Mark  Ranney. 
Henry  F.  Carriel. 
Orpheus  Everts. 
0.  M.  Langdon. 
R.  Gundryt 

Joseph  Workman. 
Dr.  Avesa. 

Illinois  State  Hospital  for  the  Insane. 
Indiana  Hospital  for  the  Insane 

Southern  Ohio  Lunatic  Asylum 

Canada: 
Provincial  Lunatic  Asxdum   

Italy: 

Provincial  Lunatic  Asylum 

Capo  di  Chino  Asylum  (private) 

Morotrolio 

Santa  Maria  di  Pieta 

Santa  Margherita  

Bonifazio  (provincial  Insane  Asylum) 

Provincial  Asylum 

San  Servalo 

Rome 

Perugia 

Florence  

Bologna 

Venice     

Joseph  Girolami^ 
(^av.  Guiseppe  Neri. 
Dr.  Cavdini.  (?) 
Frances  Foucarti.     [rio. 
P  Prosdocimo,  D.  Sale- 

St.  .John  and  St.  Paul  

Venice   

Antonio  Berti. 

Insane  Asylum 

Dufour   

Mombello 

Milan 

1  Milan           

Riiialdo  Gectano. 

F.  Franceso  Corbetta. 

Colombo 

Achille  Colombo. 

Milan 

,  Milan 

Presso  San  Celso 

!  SerafinoBiffi. 

Xame  of  Asvlum. 


Location. 


N  ame  of  Superintendent. 


Bavaeia: 
Royal  District  Asylum.... 
District  Lunatic  Asylum. 
District  Lunatic  Asvlum, 


Munich I  Aug.  Solbrig. 

Irsee  i  J.  M.  Kiderle. 

Diggendorf  |  Dr.  Ast. 


Austria:  i 

Tyrolese  Provincial  Asylum !  Hall 

Institute   for  Care  and   Cure  of  the  I 
Insane i  Linz 


Royal  Institute  for  Care  and  Cure  of 

Insane i  Vienna 

Private  Insane  Asylum '  Dobling   

As^'lum  for  Chronic  Insane j  Klosterneuberg.. 

District  Lunatic  Asylum \  Brunn,  MoravTa, 


Royal  Bohemian  Asvlum 


Prague,  Bohemia. 
Sleep,  Bohemia.... 


Saxony  and  German  States: 

Sonnenstein 

Private  Asj-lum i 

Asylum  for  Chronic  Insane 

Charity  Hospital 

District  Lunatic  Asylum 

District  Lunatic  Asylum 

Thonberg  As^'lum 

District  Lunatic  Aisylum 

District  Lunatic  Asylum 

District  Lunatic  Asylum 

Illenau  Asj^lum 


Switzerland: 

Public  As3'lum . 
Public  Asylum . 


France  : 

Department  Asylum. 

Antiquaille 

St.  Jean  de  Dieu 


Sonnenstein,  Saxony.... 

Pirna,  Saxon}" ". 

Hubertusburg,  Saxony. 

Berlin "... 

Neu.stadt,  Prussia 

Halle 

Thonberg,  near  Leipsic, 

Gottingen 

Prankfort 

Heppenheim  

Achern  


Zurich 

Waldau,  near  Berne. 


Stephansfeld  (Strasb' 
Lyons 


Joseph  Stolz. 

A.  Knorlein,  Director, 
Dr.  Schasching,  Pliy'n. 

Dr.  Spurzheim. 
Dr.  Leideidorf. 
Dr.  Mildner. 
Dr.  Lana:er. 
Dr.  Fischel. 
Dr.  Kratochril. 


H.  Lessing. 
O.  Lehman. 
George  Ehrst. 
Dr.  AVe.-tphal. 
Dr.  Sponholz. 
Dr.  Koeppe. 
E.  W.  Guntz. 
Ludwig  Meyer. 
H.  Hottman. 
Dr.  Ludwig. 
C.  Roller. 


St.  George 

Chartreuse  Asylum. 


Asylum  for  Insane  of  St.  Yonne 
St.  Anne 


La  Saltpetriere 

Doctor  Blanche's  Asylum. 

National  Asylum 

Colon}'^  Fitz  James 


Quatre-mares  St.  Yon 
St.  Yon 


D.  Gudden. 

Dr.  Fetscherin,  Phy'n, 
Dr.  Schaerer,  Direct'r 

Dr.  Hildebrand,  Phy'n, 
R.  du  Matey,  Director 
J.     Aithaud,    Director 
and   Phj'sician. 

Lyons j  Dr.  Carrier,  Physician, 

j       J.  de  Matha,  Director. 

Bourg ; 

Dijon i  Dr.  Bruno,  Director  and 

I       Phj-sician. 

A.uxerze  Dr.    "Ceilleux,    Director 

and  Pln^sician  in  Chief 

Paris I  M.    Bayent,    Director; 

I       M.  Dagonet,  Phy'n. 

Paris ,  M.  Phelip,  Director. 

Pas,=y,  Paris Dr.  Blanche. 

Charenton Dr.  Calmeil. 

Clermont |  Gustave  Labitte,  Phy'n, 

j       M.J.  Labitte,  Direct'r 

Rouen  I  Dr.  Ed.  Dumesnil. 

Rouen  '■  Dr.  Morel. 


Belgium:  !  ' 

Asylum  of  Ansard  Glaine  i  Liege Dr.  C.  Anten. 

Liege  Hospital Liege 

Colony  at  Gheel Gheel Dr.  Bulckens. 

Insane  Asylum i  Antwerp T.  Targue. 

Guislain  A.^3num j  Ghent  B.  Ingels. 

St.  Joseph Ghent   Dr.  Nermenten. 

Sts.  Julien  and  Michael I  Bruges  Dr.  Van  den  Abeele, 

Du  Strop  (private) I  Ghent  !  Dr.  Nermenten. 


Name  of  Asylum. 

Location. 

Name  of  Superintendent. 

Holland  : 
Keinier  Van  Arkol 

T.  Frybouh.  (?) 
B    H    Everts 

Meerenbers'  Asylum 

Near  Haarlam 

G.  Vrolck. 
Dr.  Stockwoll 

England: 

Kuval  Infirmary 

County  Lunatic  Asylum :.. 

Ruinhill    

T.  L.  Rogers. 

Dr.  Eagcir. 

AV.  Rhys  Williams. 

St.  Luke's  Madhouse 

Bethlem  Hospital 

Grove  Hall,  Bow 

Bo^v,  London 

County  Lunatic  Asylum 

County  Lunatic  Asylum 

Hanwell  

W.    C.    Begley,    Male 
Dep't;    J.   M.    Lind- 
say,  Female   Dep't. 

Eagar  Sheppard,   Male 
Dep't;    W.   G.   Mar- 
shall, Female   Dep't. 

Thomas  N.  Brushfield. 

S.  W.  D.  Williams. 

D.  C.  Campbell. 
G.  Thompson. 
David  Yellovvlees. 

E.  Toller. 
A.  J.  Wood. 

John  Humphrey.  . 
T.  Green. 

W.  H.  Parsey. 

John  Hitchman. 

J.  Crichton  Browne. 

J.  Kitching. 

Colney  Hatch 

Surrey  County  Lunatic  Asylvm 

Sussex  County  Lunatic  Asylum 

Essex  Lunatic  Asjdum 

Bristol  Borough  Asylum 

Glamorgan  Count}-  Lunatic  Asylum.. 
Cf)unty  Lunatic  Asylum 

Prookwood 

Hay  ward  s  Heath 

Brentwood 

Bridgend 

Wotten,  n'r  Gloucester. 
Gloucester  

Stone 

Barnwood  House 

Buckingham  County  Pauper  Lunatic 
Asylum 

Borough  Lunatic  Asylum 

B  irmin  o'ha  m 

County  of  Warwick 'Pauper  Lunatic 
Asylum 

Hatton,  near  Warwick. 

Derbyshire   County  Pauper  Lunatic 
Asylum 

W^est  Riding  Pauper  Lunatic  Asylum 

Friends'  Ketreat .■". 

York  Lunatic  Asylum 

Wakefield 

Near  York 

Y'ork 

Newcastle-upon-Tjme   Borough   Lu- 
natic Asylum  

R.  H.  B.  Wickham. 

T.  S.  Clouston. 
R.  H.  H.  Sankey. 

Cumberland  and  Wesfiiioreland  Lu- 
natic A'53dum  

Littlemorc  Asylum     

Littlemore,  Oxford 

Morningside 

Scotland: 

Edinburgh  Ro3^al  Asylum  

Saua'hton  Hall  (private) 

Dr.  Low. 
John  B.  Tuke. 

Fife  and  Kinross  District  Asylum 

The  Colony  of  Kennow^^y  

Poyal  Asylum 

Near  Cupar,  Co.  Fife... 
Kennoway 

Dundee 

Musselbureh 

James  Rorie. 

Hall  Cross  Asjdum 

District  Asylum  * 

to 

Thomas  Aitken. 
F.  W.  A.  Skae. 
Mrs.  Thompson,  Sup't; 
Dr.  Thompson,  Phy'n 
Alexander  Mackintosh. 
Lander  Lindsay. 

Robert  Stewart. 

.loseph  Lalor. 

H.A.Lodge,Sup'tMale 
Dep't;    Mary    Pry  or. 
Female  Dep't;   J.  H. 
AVharton,  Physician. 

.1    H    Hatch  ell 

District  Asylum 

Stirlin<T^           .  . 

White  House  Asylum  (private)  

Royal  Asylum 

Mussel  burtj'h 

Royal  Asylum 

Perth 

Ireland: 

District  Asylum 

Belfost 

Dublin  

County  Dublin 

Maryborough  | 

Cork  i 

Richmond  District  Asylum 

Bloomtield  Retreat 

Maryborough  Di-trict  Asjdum  

Cork  District  Lunatic  A.sylum  ' 

Killarnev  Asyluin i 

l^homu^  Power. 

Killarney 

W.  W\  Murphy. 

Central  Asylum  for  Criminal  Luna-' 
tics  1 

Dundrum ] 

NUMBER    OF    PATIENTS    IN    ASYLUMS    VISITED. 

The  number  of  patients  treated  in  these  asylums  during  the  last  year 
was  seventy-six  thousand  six  hundred  and  seven,  or  an  average  of  five 
hundred  and  fourteen  for  each  institution.  In  addition  to  the  asylums 
mentioned,  a  number  of  asylums  in  process  of  erection,  lunatic  wards  of 
Poor  Houses,  Idiot  and  Deaf  and  Dumb  Asylums,  ordinary  hospitals, 
penitentiaries,  and  other  governmental.  State,  county,  and  city  estab- 
lishments have  been  visited  and  examined,  and  such  features  noted  as 
appeared  might  at  any  time  be  of  interest  or  importance  to  the  State. 

PLANS    OF   ASYLU3IS. 

A  large  number  of  plans  of  asylums,  rules,  regulations,  etc.,  have 
been  procured,  a  portion  of  which  will  be  found  in  the  aiDpendix,  and 
all  are  at  the  service  of  the  State. 

STATISTICAL     TABLES. 

The  statistical  tables  have  cost  much  time  and  patient  labor,  and  are 
believed  to  be  as  complete  as  any  ever  published  on  this  subject,  and 
the  facts  set  forth  in  them  have  been  gathered  from  the  latest  and  most 
reliable  sources  known  to  exist. 

MEETINGS    OF    SUPERINTENDENTS    ATTENDED. 

It  has  been  our  good  fortune  to  have  attended  the  meeting  of  the 
Superintendents  of  American  Institutions  for  the  Insane  at  Hartford 
last  year,  and  those  of  a  similar  character  for  France,  in  Paris,  and  of 
Great  Britain,  in  London  during  the  present  year.  It  is  needless  to 
dilate  upon  the  high  character  and  intellectual  capa(*ity  that  distinguish 
the  men  who  compose  these  associations,  nor  upon  the  great  service 
they  have  rendered  to  humanity  by  sending  forth  the  results  of  their 
individual  and  collective  experiences  to  enlighten  mankind  and  relieve 
the  distresses  of  their  fellow  men.  They  are  the  rays  of  light  that 
dispel  the  mists  and  drive  away  the  thick  clouds  by  which  the  mind  of 
man  is  enveloped  when  the  brain  is  diseased.  "  Their's,  indeed,  is  a  mis- 
sion of  mercy,  and  verily  they  shall  reap  their  reward." 

IMPORTANCE  OF  SUCH  3IEETINGS. 

So  important  do  these  annual  meetings  appear  to  our  mind  we  do  not 
hesitate  to  express  the  opinion  that  it  should  be  made  the  duty  of 
the  Superintendent  of  every  asylum,  or  an  assistant,  to  attend  each 
meeting,  feeling  assured  that  the  opportunity  presented  for  an  inter- 
change of  opinions  with  those  engaged  in  a  like  calling  could  not  fail  to 
be  both  agreeable  and  instructive  to  himself,  but  beneficial  to  those  com- 
mitted to  his  care  and  the  State  in  whose  service  he  is  engaged.  We 
feel  under  especial  obligations  to  them,  and  to  all  others  who  have  con- 
tributed to  our  pleasure  or  added  to  our  stock  of  information, 

BOOKS    OBTAINED    FOR    STATE    LIBRARY. 

A  large  number  of  books,  reports,  and  essays  on  insanity  and  State 
medicine  have  been  obtained  for  the  State  Library  by  purchase  or  dona- 


tion  from  various  sources  and  countries,  comprising  in  the  list  nearly  all 
of  the  standard  works  of  the  most  celebrated  authors  who  have  written 
upon  the  subject  of  insanity,  and  the  most  recent  .^ind  reliable  informa- 
tion on  the  statistics  of  lunacy  that  could  he  found.     Among  these  arc 
the  works  of  Allen,  Anderson,  Arlidge,  Bingham,  Browne,  Bucknill  and 
Tuke,  Burrows,  ConoUy,  Crowther,  Dunn,  Ellis,  Gall,  Hill,  Hills,  Hoods, 
Jacohi,    Morrison,    Pricbard,    Seymour,    Sicveking,    A\"illiams,   Winslow, 
including  Journal  of  Psychological  Medicine,  1848  to  1863,  and  the  more 
recent  p'l'oductions  of  Van  Der  Kolk,  Brown,  Sankey,  Mandsley,  Blan- 
ford,  Fry,  Casper,  Griesinger,  Davis;  translation  of  Pinel,  Cox,  Liddell; 
translation  of  Esquirol,  Mayo,  and  a  set  of  the  Journal  of  Mental  Science 
from  commencement  of  volume  two  to  the  present  time.     Also,  very 
nearly  a  complete  set  of  the  Eeports  of  the  Commissioners  in  Lunacy, 
and  either  valuable  documents  presented  by  Mr.  Wilkes,  one  of  the  Com- 
missioners; a  partial  set  of  the  Eeports  of  the  Scotch  Commissioners,^ 
and  other  documents  presented  by  Sir  James   Cox  and  Dr.  Sibbald,  of 
that  Board;  the  last  Keport  of  the  Commissioners  for  Heland;  special 
reports  of  all  the  asylums  visited,  where  these  were  published  and  attain- 
able; essays  on  a  variety  of  subjects;  rules  and  regulations  of  asylums, 
general  and  special;  descriptioflis  of  asylums  by  sundry  persons;  reports 
of   Special  Commissioners,  aiid  many  other  documents  of  more  or  less 
interest.     Among  the  French  works  will  be  found  those  of  Foville,  Dag- 
onet,  Calmiel,  Falvet,  Morel,  Mundy,  Motet,  and  others.     From  Prussia, 
a  volume  of  general  statistics  for  eighteen  hundred  and  sixty-seven;  a 
valuable  treatise  on  construction  and  plans  of  asylums  for  the  insane, 
containing  the  opinions  of  many  of  the  most  eminent  psychologists  of 
that  country,  and  a  brief   account  of   all  the  asylums  of   the   German 
Confederation    in    eighteen    hundred   and  sixty-five,  by  Dr.  H.  Laeur, 
together  w^ith  a  few  other  documents  of  minor  importance.     Besides  the 
reports,  more  or  less  complete,  of  all  the  asylums  visited  in  the  United 
States,  a  variety  of  documents,   including  statistics   of  the  insane  and 
idiotic  for  eighteen   hundred  and  seventy,  essays,  lectures;   reports  of 
Commissioners  sent  into  other  States  and  countries,  and  those  of  a  local 
character:    reports  of  Boards  of  Charity  of  New- York,  Massachusetts, 
Ohio,  and'  Pennsylvania,  of  the  Cities   of  New  York  and  Boston,  and  a 
number  of  other  documents  of  interest  and  importance,  and  from  most 
countries  plans  of  asylums,  more  or  less  complete,  of  some  of  the  best 
institutions  known  to  exist,  embracing  every  variety,  from  the  palatial 
hosj^ital  to  the  modest  cottage. 

The  professional  man  will  find  much  that  is  trite  and  familiar  in  this 
report,  but  it  must  not  be  forgotten  that  it  is  not  so  much  for  him  as  for 
the  public  that  it  has  been  prepared. 

SOURCES    OF    INFORMATION. 

The  information  which  it  contains  has  been  derived  from  various 
sources.  The  work  of  other  men's  brains  has  been  freely  appropriated. 
Their  experiences  we  have  endeavored  to  use  to  the  best  advantage;  and 
even  the  errors  commxitted  by  some  of  them  have  taught  us  valuable 
lessons,  as  it  is  sometimes  as  necessary  to  kiiow  what  to  avoid  as  what 
to  adopt. 

ACKNOWLEDGMENTS. 

Much  has  also  been  learned  from  personal  intercourse  with  men  of 
ability  in  all  the  countries  we  have  visited,  and  we  can  never  forget  nor 


ever  cease  to  be  grateful  for  the  many  acts  of  courtesy,  kindness,  and 
attention  that  we  have  received  at  their  hands.  To  Drs.  Shurtleff,  Strib- 
bling,  Kirkbride,  Gray,  Buttolph,  and  AYalkar,  in  each  of  whose  estab- 
lishments we  spent  several  days  in  the  early  part  of  our  investigations, 
"we  are  especially  indebted  for  the  kind  manner  in  which  they  took  us 
by  the  hand  and  started  us  "  right  foot  foremost ''  in  the  path  of  our 
duty.  Nor  have  we  forgotten  the  attentions  and  courtesies  of  a  single 
Superintendent  whose  asylum  we  visited  in  America  or  Europe. 


CHAPTEE    II. 
IXSAXITY  A  DISEASE  OF  THE  BEAI?^. 

What  is  insanity?  This  question  has  been  often  asked,  but  perhaps 
has  never  been  satisfactorily  answered,  for  the  simple  reason  that 
insanity  assumes  so  many  forms  and  differs  so  widely  in  different  per- 
sons that  no  definition  can  possibly  embrace  all  of  its  phases.  Many 
persons  have  given  definitions  of  this  subtle  malady,  but  not  one  has 
met  with  that  universal  concurrence  necessary  to  render  it  the  true  and 
only  or  even  the  generally  received  definition.  We  do  not  propose  to 
enter  this  list,  but  as  much  must  be  said  on  the  subject  in  the  following 
pages  it  is  best,  perhaps,  that  a  selection  should  be  made. 

In  a  lecture  delivered  before  the  Eoyal  College  of  Surgeons,  March 
first,  eighteen  hundred  and  sixty-one,  by  David  Skae,  M.  D.,  F.  E.  C.  S., 
Physician  to  the  Eoyal  Edinburgh  Asylum,  he  defined  it  to  be  "a  disease 
of  the  brain  affecting  the  mind."  We  accept  this  definition  as  the  best 
of  all,  because  it  is  the  most  simple.  It  makes  but  little  difference  how 
the  brain  becomes  diseased,  whether  primarily  or  by  reflex  action  from 
the  disease  of  some  other  organ  of  the  body,  so  the  fact  as  stated  be 
true  that  the  brain  must  be  diseased  ere  the  mind  is  affected. 


CHAPTEE     III. 
INSANITY  AS  IT  XOW  EXISTS. 

The  Subject  Gonerajly — Insanity  in  England— In  Scotland — In  Ireland — In  France — In 
Italy — In  Prussia — In  Austiia — In  German  States — In  Bavaria — In  Switzerland — In 
Belgium — In  Holland — In  D.-nmark — In  Sweden — In  Norway — In  New  South  AYales 
— In  the  United  States — In  California. 

THE    SUBJECT    GENERALLY. 

In  considering  the  subject  of  insanity,  it  is  proper  first  to  inquire  to 
what  extent  it  exists  in  the  world  and  in  our  midst.  To  do  this  we  have 
prepared  tables  exhibiting  the  i^opulation  of  various  countries,  divided 
into  self  supporting  and  pauper  classes  (where  these  have  been  sepa- 
rated), and  ni  all  cases  the  total  loopulation,  number,  and  distribution  of 
the  insane  at  the  latest  dates  at  which  these  facts  could  be  obtained; 
the  proportion  of  the  insane  to  j^opulation,  the  ratio  per  thousand,  the 
proportion  of   pauj^er  insane    to    pauper  poj^ulation,  the   j^roportion  of 


insane  under  treatment  to  population,  the  number  in  hospitals  and  asy- 
lums at  latest  chite;  numbers  admitted,  cured,  died,  and  treated  during 
the  year;  the  number  of  asylums  in  each  country;  the  principal  assigned 
causes  of  the  disorder  and  of  death;  together  with  the  nundx'rs  resident 
at  beginning  of  the  year;  numbers  admitted,  cured,  and  died  during  the 
year,"and  the  percentage  of  recoveries  and  of  deaths  to  admissions  and 
to  numbers  treated  in  the  asylums  visited  in  different  countries;  to 
which  we  have  added  similar  facts  for  jSTorway,  Sweden,  and  the  Colony 
of  New  South  Wales. 

INSANITY    IN    ENGLAND. 

Populatioi,  1870. 


Self  supporting  classes 
Paupers 

Total  population... 


21,006,631 
1,083,532 


22,090,103 


Number  and  Distribution  of  the  Insane,  January  1st,  1870. 


County  and  Borough  A  sylums 

Registered  Hospitals  

Metropolitan  Licensed  Houses 

Provincial  Licensed  Houses 

JSTaval  and  Military  Hospitals  and  Eoyal  India 

Asylum  

Workhouses 

With  relatives  or  others 

Broadmoor  Criminal  Asylum 


Totals 


Private. 


259 
1,969 
1,666 
1,478 

198 


356 
354 


6,280 


Pauper. 


27,721 

400 

1,034 

■726 


11,358 

7,086 

108 


48,43^ 


Totals. 


27,980 
2;369 
2,700 
2,204 

198 

11,358 

7,442 

462 

54,713 


Proportion  of  insane  to  population,  one  in  four  hundred  and  three;  or, 
ratio  per  one  thousand,  two  and  forty-seven  one  hundredths.  Propor- 
tion of  pauper  insane  to  j^auper  population,  one  in  twenty-two;  or,  ratio 
per  one  thousand,  forty-four  and  sixty-nine  one  hundredths.  Proportion 
of  insane  (under  treatment)  to  population,  one  in  six  hundred  and  tifteen; 
or,  ratio  per  one  thousand,  one  and  sixty-two  one  hundredths. 


The    number    of   Insane    in    Hospitals,  Asylums,  and    Licensed 

Houses,  January  1st,   1870 

Admitted  during  the  year 

Cured 

Died  

Number  treated  in  1870 


35,913 

11,462 

3,955 

3,790 

47,375 


10 


Per  cent  of  recoveries  on  admissions |  34 

Per  cent  of  recoveries  on  number  treated  i  8 

Per  cent  of  deatlis  on  admissions i  33 

Per  cent  of  deaths  on  number  treated !  8 


Number  of  Asylums,  etc.,  for  the  Insane  in  England  and  Wales. 


County  and  Borough  Asylums 

Eegistered  Hospitals 

State  Asylums 

Metropolitan  Licensed  Houses 

Provincial  Licensed  Houses 

Total  number  of  Listitutes  for  the  Lisane 


50 
16 
4 
41 
65 

176 


The  average  weekly  cost  per  head  in  County  Asylums  is  nine  shillings 
five  and  one  eighth  pence,  or  two  dollars  and  twenty-eight  cents. 

The  principal  assigned  causes  of  insanity  are:  hereditary,  intemper- 
ance, domestic  tj-ouble,  epilepsy,  mental  anxiety,  puerperal  condition  and 
critical  period,  paralysis. 

The  principal  causes  of  death  are:  general  paralysis,  diseases  of  the 
lungs,  diseases  of  the  brain,  epilepsy,  debility  and  old  age,  apoplexy. 


In  twenty  asylums  visited  in  1870,  the  number  of  patients  resi- 
dent was 

Admitted 

ISTumber  treated 

Cured 

Died  


Per  cent  of  cures  on  admissions 

Per  cent  of  cures  on  number  treated.. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated. 


12,116 
3,670 

15,786 
1,369 
1,220 


37 

8 

33 


INSANITY    IN    SCOTLAND. 

Fopulafion,  January  1st,  1870. 


Self  supporting  classes 

Paupers  (May  14th,  1869) 

Total  population 


3,142,503 


3,222,837 


11 


Number  and  Distribution  of  the  Insane. 


Private. 


Pauper. 


Totals 


In  Eoval  and  District  Asylums.... 

lu  Private  Asylums 

In  Parochial  Asylums 

In  Lunatic  Wards  of  Poorliouses.. 

In  General  Prison 

In  Training  Schools  for  Imbeciles. 
In  Private  Dwelling's 


914 
249 


Totals,  January  1st,  1870. 


49 


1,295 


3,547 

54 

553 

574 

49 

30 

1,4G9 

6,276 


4,461 
303 
553 
574 
49 
113 

1,518 

7,571 


Besides  the  number  of  insane  given  above,  it  is  estimated  that  there 
are  about  two  thousand  unreported,  making  the  total  number  nine  thou- 
sand five  hundred  and  seventy-one. 

Proportion  to  the  population,  one  in  three  hundred  and  thirty-six;  or, 
ratio  per  one  thousand,  two  and  ninety-six  one  hundredths.  Proportion 
of  insane  (under  treatment)  to  population,  one  m  six  hundred  and  six; 
or,  ratio  per  thousand,  one  and  sixty-four  one  hundredths.  Proportion 
of  pauper  insane  to  pauper  population,  one  in  thirteen;  or,  ratio  per  one 
thousand,  seventy-eight  and  twelve  one  hundredths. 


JSTumber  of  insane  lu  asylums,  January  1st, 

Admitted  during  the  year 

Cured 

Died  


1870. 


IST umber  treated  in  1870. 


5,317 
2,015 

832 

491 

7,832 


Per  cent  of  recoveries  to  admissions 

Per  cent  of  recoveries  to  number  treated. 

Per  cent  of  deaths  to  admissions 

Per  cent  of  deaths  to  number  treated 


41 
11 
24 


Number  of  Institutions  for  the  Insane. 


District  Asylums 

Poyal  A  sy lums 

Private  Asylums 

Parochial  Asylums 

Total  Asylums 

Lunatic  Wards  of  Poorhouse 

Total 


10 

7 
9 


31 
15 

46 


12 

The  average  weekly  cost  of  maintenance  of  pauper  lunatics  in  Eoyal 
and  District  Asylums  is  nine  shillings  and  nine  and  one  fourth  pence;  in 
Private  Asylums,  ten  shillings  and  two  and  a  half  pence;  in  Parochial 
Asylums,  eight  shillings  and  five  and  a  half  pence;  making  a  general 
average  cost  of  nine  shillings  and  five  and  three  fourths  pence,  or  two 
dollars  and  twenty-nine  cents. 

The  principal  assigned  causes  of  insanity  are:  climacteric  changes,  old 
age,  intemperance,  child  bearing. 

The  principal  causes  of  death  are:  consumption,  general  debility  and 
old  age,  organic  disease  of  brain,  inflammation  of  lungs,  general  paral- 
ysis. 


In  six  asylums  visited  in  1870,  the  number  of  patients  resident 
was 

1  995 

Admitted 

1  030 

Treated 

3,025 
365 

Cured 

Died 

206 

Per  cent  of  cures  on  admissions I  35 

Per  cent  of  cures  on  number  treated 12 

Per  cent  of  deaths  on  admissions ;  20 

Per  cent  of  deaths  on  number  treated 6 

i 


INSANITY   IN    IRELAND. 

Pojndatioii,  1870. 
Total  population 5,195,236 

Number  and  Distribution  of  the  Insane^  December  31.?f,  1870. 


. 

Private. 

Pauper. 

Totals. 

In  District  Asjdums 

122 

638 

6,533 

6  655 

In  Private  Asylums 

638 

In  Jail 

1 

2,754 

43 

167 

1 

In  Workhouses  

">  754 

In  Lucan 

43 

In  Central 

167 

Lunatics  at  large 

6,936 
7,696 

6  936 

Totals  

9,498 

17  1Q4 

Proportion  of  insane  to  population,  one  in  three  hundred  and  two;  or, 
ratio  per  one  thousand,  three  and  thirty  one  hundredths.     Proportion  of 


13 


insane  (under  treatment)  to  population,  one  in  seven  hundred  and  twenty- 
nine;  or,  ratio  i^er  one  thousand,  one  and  thirty-seven  one  hundredths. 


Number  of  insane  in  asylums,  January  1st,  1870 '  7,121 

Admitted  during  the  year 2,532 


Cured. 


1,088 


Died 708 

Number  treated  in  1870 '   9,Go.3 


Per  cent  of  reco'veries  on  admissions 43 

Per  cent  of  recoveries  on  number  treated I  H 

Per  cent  of  deaths  on  admissions 27 

Per  cent  of  deaths  on  number  treated 


Number  of  EstablisJiments-for  the  Insane. 


District  Asylums  23 

Private  Licensed  Houses ;  20 

Asylums  for  Criminals ;  1 

Total I  44 


The  average  weel^ly  cost  per  head  in  District  Asylums  is  eight  shill- 
ings and  eleven  and  a  half  pence,  or  two  dollars  and  seventeen  cents. 

The  principal  assigned  causes  of  insanity  are:  hereditary,  grief,  fear 
and  anxiety,  intemperance  and  irregularity  of  living,  disease  of  the 
brain,  bodily  injuries  and  disorders. 

The  principal  causes  of  death  are:  thoracic  disease,  cerebral  disease, 
debility,  and  old  age. 


In  eleven  asylums  visited 

dent  was 

Admitted 

Treated 

Cured 

Died 


1870,  the   number   of  patients 


resi- 


2,437 

1,206 

3,043 

457 

256 


Per  cent  of  cures  on  admissions 

Per  cent  of  cures  on  number  treated.. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated. 


37 
12 
21 

7 


14 

INSANITY   IN    FRANCE. 

Population,  1866 37,988,905 

Xumber  and  Distribution  of  the  Insane,  1866. 


Insane.         Idiots. 


Totals. 


In  asylums 31,992  ;     3,980 

At  home 18J34  |  35^973 


Totals 50.726      39,953 


35.972 
54,707 

90,679 


i     Males. 


Females. 


Totals. 


Insane I   24.190  |  26,537  |   50.726 

Idiots f   22,736   I   17,217   |  39,953 


Proportion  of  insane  to  population,  one  in  seven  hundred  and  forty- 
seven;  or,  ratio  per  one  thousand,  one  and  thirtv-three  one  hundredths. 
Proportion  of  idiots  to  population,  one  in  nine  hundred  and  fifty.  Pro- 
portion of  insane  and  idiots  to  population,  one  in  four  hundred  and 
eighteen;  or,  ratio  per  one  thousand,  two  and  thirty-eight  one  hun- 
dredths. Proportion  of  insane  and  idiots  (under  treatment)  to  popula- 
tion, one  in  one  thousand  and  fifty-seven;  or,  ratio  per  one  thousand, 
ninety-four  one  hundredths. 


Population,  1860. 


170.942 


J^umber  of  insane  in  hospitals  and  asylums.  January  1st,  I860.. 

Admitted  during  the  year 

Cured  or  improved 

Died  ,,'''', 

Number  treated  in  1860 


28.761 

10,786 

4,337 

4,970 

39,546 


Per  cent  of  recoveries  on  admissions 

Per  cent  of  recoveries  on  number  treated. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated 


40 
11 
46 

12 


Xumbl?r  of  Asylums  for  the  Insane  in  eighteen  hundred  and  sixty 
(public  and  private  establishments),  ninety-nine. 

In  eighteen  hundred  and  fifty-three,  the  average  weekly  cost  per 
head  was  one  dollar  and  twenty-one  cents. 


15 


The  principal  assigned  causes  of  insanity,  as  per  reports  eighteen  hun- 
dred and  fifty-three,  were:  hereditary,  epilepsy  and  convulsions,  intem- 
perance, destitution  and  misery,  loss  of  fortune. 

The  principal  causes  of  death:  paralysis,  disease  of  brain,  pneumonia, 
insanity,  brain  fever. 


In  thirteen   asylums   visited  in   1870,  the   number   of  2")aticnts 

resident  was 

Admitted  (in  eleven  of  these) 

*  Cured  (in  eleven  of  these) ^:;rrs!!?»5!2^ . . .- 

Died  (in  eleven  of  these) /■^..'^XJ^.i.tc'.^»?':>^. 

•' -i- ^'.^^ 


4 


Number  treated  (in  eleven  of  these) 


^ 


7,938 

3,324 

873 

1,292 

11,262 


^ 


Per  cent  of  recoveries  on  admissions......... 

Per  cent  of  recoveries  on  number  treated... 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated 


•••e>^^4 


26 

7 

38 

11 


INSANITY    IN    ITALY. 

Population,  1864 22,291,181 

By  the  addition  of  Yenice,  in  1866,  the  population  was  increased  to 
24,263,320. 

]N"umber  of  insane  in  asylums,  January  1st,  1867 8,191 

Proportion  of  insane  (under  treatment)  to  population,  one  in  two 
thousand  nine  hundred  and  sixty-two;  or,  ratio  per  one  thousand,  thirty- 
three  one  hundredths. 


]N"umber  in  asylums,  January  1st,  1867 

8,191 
4,909 
3  210 

Admitted 

Discharii^ed  

Died  

1,504 
13,100 

JS'umber  treated  during  the  year 

Number  remaining  January  1st,  1868 

8,386 

Per  cent  of  discharges  on  admissions 

Per  cent  of  discharges  on  number  treated 

Per  cent  of  deaths  on  admissions , 

Per  cent  of  deaths  on  number  treated 


65 
24 
30 
11 


*  Leaving  out  the  Asylum  La  Salpetriere  (for  chronic  cases  only),  the  per  cent  of  cures 
on  admissions  would  be  twenty-seven. 


16 

Fifteen  asylums  were  visited  in  eighteen  hundred  and  seventy. 


In  fourteen  of  these  the  number  resident  was 

In  thirteen  of  these  the  admissions  were 

In  twelve  of  these  the  number  treated  was 

In  thirteen  of  these  the  number  cured  was — 
In  thirteen  of  these  the  number  died  was 


4,259 

1,967 

5,816 

764 

621 


Per  cent  of  recoveries  on  admissions 38 

Per  cent  of  recoveries  on  number  treated 13 

Per  cent  of  deaths  on  admissions 31 

Per  cent  of  deaths  on  number  treated 10 


The  average  w^eekly  cost  of  maintenance  of  indigents  in  eight  public 
asylums  is  one  dollar  and  seventy-seven  cents. 

Principal  causes  of  death:  disease  of  the  lungs,  paralysis,  marasmus. 

Principal  assigned  causes  of  insanity:  pillagra,  hereditary,  intemper- 
ance. 


INSANITY   IX    PRUSSIA. 

Population,  1864 19,252,363 

jVumber  of  Insane   Under  Treatment. 


In  Public  Asylums  . 
In  Private  Asylums 

Total 


4,796 
944 


5,740 


Proportion  of  insane  (under  treatment)  to  poj^ulation,  one  in  three 
thousand  three  hundred  and  fifty-four;  or,  ratio  per  one  thousand, 
twenty-nine  one  hundredths. 

Number  of  Asylums. 


Public  Asylums i     32 

Private  Asylums |     27 

Total I     59 

. L 

Expenses  of  Public  Asylums,  six  hundred  and  fourteen  thousand  six 
hundred  and  sixtj^-four  thalers,  or  four  hundred  and  forty-eight  thou- 
sand seven  hundred  and  four  dollars  and  seventy -two  cents,  which  gives 
a  weekly  cost  per  head  of  one  dollar  and  eighty  cents. 


17 


In  two  asylums  visited  in  1870,  the  number  of  patients  resident 

was 

Admitted 

Cured 


Died  

Number  treated 


1,065 
297 
105 
110 

1,362 


Per  cent  of  cures  on  admissions 

Per  cent  of  cures  on  number  treated.. 

Per  cent  of  deaths  on  admissions  

Per  cent  of  deaths  on  number  treated 


35 

7 

37 

8 


The  average  weekly  cost  of  maintenance  of  indigents  in  these  two 
asylums  is  one  dollar  and  ninety-five  cents. 

Principal  assigned  causes  of  insanity:  The  Director  at  Halle  says  that 
eighty  per  cent  of  cases  of  insanity  are  from  hereditary  causes. 

Principal  causes  of  death:  general  paralysis,  epilepsy. 

Population,  December,  1867 23,971,337 


The  total  number  of  insane. 
The  total  number  of  idiots . 


Total  number  of  unsound  mind. 


16,929 
21,031 

37,960 


Proportion  of  insane  and  idiots  to  poj^ulation,  one  in  six  hundred 
and  thirty-one,  or  ratio  per  one  thousand 

Proportion  of  insane  to  poj^ulation,  one  in  fourteen  hundred  and 
sixteen,  or  ratio  per  one  thousand 


1.58 
.70 


Population,  1864 


INSANITY   IN   AUSTRIA. 

German  Austria^  exclusive  of  Hungary, 
Number  of  Insane  in  Asylums. 


13,000,000 


In  Public  Asylums  . 
In  Private  Asylums 

Total 


3,065 
150 


3,215 


18 


Proportion  of  insane  (under  treatment)  to  population,  one  in  four 
thousand  and  forty-three,  or  ratio  per  one  thousand 


.24 


Number  of  Asylums. 


Public  Asylums.. 
Private  Asylums. 

Total 


14 
4 

18 


Expenses  of  Public  Asylums,  eight  hundred  and  seventy-three  thou- 
sand seven  hundred  and  fifty-six  florins,  or  four  hundred  and  twenty- 
two  thousand  eight  hundred  and  ninety-seven  dollars  and  ninety  cents, 
which  gives  an  average  weekly  cost  per  head  of  two  dollars  and  sixty- 
five  cents. 


In  six  asylums  visited  in  1870,  the  number  of  patients  resident' 

was 2  302 


Admitted 

Cured , 

Died 

Number  treated. 


1,741 
377 
543 

4,043 


Per  cent  of  cures  on  admissions 

Per  cent  of  cures  on  number  treated.. 

Per  cent  of  deaths  on  admissions 

"^Per  cent  of  deaths  on  number  treated. 


21 

9 

31 

13 


_  The  new  asylum,  Klosterneuberg,  was  also  visited.  It  was  opened  in 
eighteen  hundred  and  seventy,  so  there  was  no  report  for  the  year.  The 
number  resident  was  one  hundred  and  twenty-three. 

The  average  weekly  cost  of  maintenance  of  indigents  in  the  Public 
Asylums  visited  was  two  dollars  and  thirty-nine  cents. 

The  Statistical  Bureau  gives  three  hundred  and  ninety-seven  thousand 
and  ninety  dollars  as  the  cost  of  supporting  four  thousand  four  hundred 
and  ninety-nine  pauper  patients  in  eighteen  hundred  and  sixty -nine — ■ 


An  annual  cost  per  head  of. 
A  weekly  cost  per  head  of.. 


§88  26 
1  70 


The  principal  assigned  causes  of  insanity:  inherited  or  congenital 
tendency,  affliction,  poverty,  remorse,  intemperance. 

The  principal  causes  of  death:  disease  of  the  lungs,  paralysis  of  the 
brain,  marasmus.     , 


19 

INSANITY   IN    THE    GERMAN    STATES. 

Population,  1864 13,747,637 

Number  of  Insane  in  Asylums  and  Ilosjntals. 


In  Public  Asylums... 
In  Private  Asylums. 


Total 


9,962 
633 


10,595 


Proportion  of  insane  (under  treatment)  to  population,  one  in  twelve j 

hundred  and  ninety-seven,  or  ratio  per  one  thousand .77 


Number  of  Asylums. 


Public  Asylums... 
Private  Asyhmis. 


Total. 


46 

18 

64 


In  ten  asylums  visited  in  1870,  the  number  of  patients  resident 

was 

Admitted 

Cured 


Died 

Number  treated. 


2,495 

1,046 

276 

290 

3,541 


Per  cent  of  cures  on  admissions 

Per  cent  of  cures  on  number  treated.. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated. 


26 

7 

27 

8 


At  Illenau  the  numbers  for  ten  years  were  obtained, 
follows: 

They  were  as 

A  dmiRRions                                                                               

4,086 

Cures                                                         

1,570 

Deaths                           .                

597 

"Nninlipr  tTPatpd                                                

4,512 

20 


Per  cent  of  cures  on  admissions 

Per  cent  of  cures  on  number  treated.. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated. 


38 
34 
14 
13 


The  average  weekly  cost  of  maintenance  for  indigents  in  the  Public 
Asylums  visited  was  one  dollar  and  sixty  cents. 


INSANITY   IN    BAVARIA. 

Population,  1864 4,807,440 

Xumher  of  Insane   Under  Treatment. 


In  Public  Asylums.. 
In  Private  Asylums. 


Total 


1.831 
19 

1,850 


Proportion  of  insane  (under  treatment)  to  population,  one  in  two! 
thousand  five  hundred  and  ninety-eight,  or  ratio  per  one  thou-! 
sand ! 


Nwnher  of  Asylums. 


Public  Asylums.. 
Private  Asylums. 


Total. 


9 
2 

11 


In  1861  the  population  was !  4,689,837 


The  total  number  of  insane 

Proportion  to  2Dopulation,  one  in  nine  hundred  and  fifty-seven, 

or  ratio  per  one  thousand 


4,899 
1.04 


In  the  six  District  Lunatic  Asylums  the  number  of  2^atients  Octo- 
ber 1st,  1865,  was 

Admitted  during  the  year 

Cured 


Died 

Number  treated  in  1865-6. 


1,651 
529 
171 
150 

2,180 


21 


Per  cent  of  recoveries  on  admissions 

Per  cent  of  recoveries  on  number  treated. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated 


32 
7 

28 
6 


The  average  weekly  cost  of  maintenance  per  head  in  the  above  Dis- 
trict Asylunis  was,  in  18G5-G,  two  doHars  and  fifty-three  cents. 

Causes  of  insanity  not  specified;  but  in  about  twenty-nine  per  cent  of 
the  whole  number  of  cases  the  insanity  was  hereditary. 

The  principal  causes  of  death:  consumption,  general  paralysis,  pleurisy 
and  pneumonia,  marasmus. 


In  three  asylums  visited  in  1870,  the  number  of  patients  resident 


Admitted 

Cured 

Died  

Number  treated. 


658 
324 
112 

57 

982 


Per  cent  of  recoveries  on  admissions 

Per  cent  of  recoveries  on  number  treated. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated 


34 
11 

'I 


INSANITY   IN    SWITZERLAND. 

Population,  1860 2,510,494 


In  two  asylums  visited  in  1870,  the  number  of  patients   resident 
was 


462 


The  report  for  the  asylum  at  AValdau  is  as  follows: 


Number  resident I  -"^^ 

Admitted |     ^^ 

Cured ?^ 

Died I     1^ 

Number  treated i  ^*^ 


22 


Per  cent  of  cures  on  admissions ■     38 

Per  cent  of  cures  on  number  treated I       8 

Per  cent  of  deaths  on  admissions I     22 

Per  cent  of  deaths  on  number  treated I       5 

i 
i  . 

Average  weekly  cost  of  maintenance  of  indigents  is  one  dollar  and 
sixteen  cents. 


INSANITY   IN   BELGIUM. 

Population,  1865 4,984,451 

Number  and  Distribution  of  the  Insane,  December  Slsf,  1865. 


Private. 

Pauper. 

Totals. 

In  hospitals  and  asylums , 

1,579 

2,000 

3,852 

5,431 

Estimated  number  at  large  who  are 
their  families 

supported  by 

Totals 

3,579 

3,852 

7  431 

Proportion  of  insane  to  population,  one  in  six  hundred  and  seventy! 

one,  or  ratio  per  one  thousand i   1.49 

Proportion  of  insane  (under  treatment)  to  population,  one  in  nine' 

hundred  and  seventeen,  or  ratio  per  one  thousand j   1.09 

.  i 


Number  of  insane  under  treatment  in  hospitals,  January  1st,  1865.'   5,441 

Admitted  during  the  year I   1,851 

Cured !      642 


Died 

Number  treated  in  1865. 


595 
7,292 


Per  cent  of  recoveries  on  admissions \  34 

Per  cent  of  recoveries  on  number  treated I  8 

Per  cent  of  deaths  on  admissions :  32 

Per  cent  of  deaths  on  number  treated 8 


23 


Number  of  Asylums  for  the  Insane,  1865. 


For  male  patients  only  . . 
For  female  patients  only 
For  both  sexes 

Total 


17 
17 
17 

51 


Twenty-seven  of  these  asylums  are  for  private  patients  and  paupers; 
sixteen  are  for  private  patients  only,  and  eight  for  paupers  only. 

The  average  weekly  cost  of  pauper  patients  varies  from  live  francs 
and  four  centimes  to  ten  francs  and  fifty  centimes,  or  from  ninety-five 
cents  to  two  dollars. 

The  fifty-one  asylums  of  Belgium  have  a  total  capacity  of  five  thou- 
sand three  hundred  and  eighty-seven  patients. 

The  principal  assigned  causes  of  insanity  are:  poverty,  losses,  etc., 
intemperance,  domestic  trouble,  disappointment. 

The  principal  causes  of  death  are:  cerebral  marasmus,  general  paral- 
ysis, consumption,  chronic  bronchitis. 


In  eight  asylums  visited  in  1870,  the  number  of  patients  resident 


Admitted  into  five  of  these  asylums. 

Treated  in  five  of  these  asylums 

Cured  in  five  of  these  asylums 

Died  in  five  of  these  asylums 


3,029 
769 

3,567 
232 
311 


Per  cent  of  recoveries  on  admissions 

Per  cent  of  recoveries  on  number  treated. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated 


30 
8 

40 
8 


INSANITY   IN    HOLLAND. 

Population,  1868 T. 3,592,415 


Number  of  patients  in  Lunatic  Hospitals,  January  1st,  1868. 

Admitted 

Cured 


Died  

Number  treated  in  1868. 


3,179 
994 
380 
358 

4,173 


24 


Per  cent  of  cures  on  admissions 

Per  cent  of  cures  on  number  treated . . 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated. 


38 

9 

36 

8 


Proportion  of  insane  (in  asylums)  to  population,  one  in  eleven  hun- 
dred and  thirty,  or  ratio  j^er  one  thousand 


.88 


Number  of  Lunatic  Asylums 12 

Cost  of  2Iaintenance. 

At  Peinier  Yan  Arkel: 

First  clasSj  seven  hundred  florins,  and  twenty-five  florins  as  entrance 
fee. 

Second  class,  four  hundred  florins,  and  twelve  florins  as  entrance  fee. 

Third  class,  two  hundred  and  twenty-five  florins,  and  are  clothed  by 
the  Institute. 

At  Meerenberg: 

First  class,  one  thousand  florins. 

Second  class,  seven  hundred  and  fifty  florins. 

Third  class,  five  hundred  florins. 

Fourth  class,  three  hundred  florins. 

Fifth  class,  two  hundred  and  seventy  florins. 

At  Eotterdam  (for  indigents) : 

Two  hundred  and  forty  florins.  Twelve  other  patients  pay  one  florin 
per  day  extra  for  better  accommodations. 

Average  weekly  cost  for  indigents,  one  dollar  and  eighty-eight  cents. 

The  principal  assigned  causes  of  insanity  (mentioned  in  reports)  are: 
hereditary,  intemperance. 

The  principal  causes  of  death  are:  marasmus,  consumption,  apoplexy, 
general  paralysis. 


In  three  asylums  visited  in  1870,  the  number  of  patients  resident 

was * 

Admitted 

Treated 

Cured 

Died 


1,245 
321 

1,566 
123 
145 


Per  cent  of  recoveries  on  admissions 

Per  cent  of  recoveries  on  number  treated. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated 


38 
7 

45 
9 


25 


INSANITY  IN   DENMARK. 


Population,  1860 

Total  number  of  insane. 


2,005,024 


5,135 


Proportion  to  population,  one  in  five  hundred  and  seven,  or  ratio 
per  one  thousand 


1.97 


Proportion  of  insane  (under  treatment)   in  public  institutions  to  pop- 
ulation, one  in  sixteen  hundred  and  thirteen.* 


INSANITY   IN    SWEDEN. 


Population,  1860 

Total  number  of  insane. 


3,859,728 
7,512 


Proportion  of  insane  to  population,  one  in  five  hundred  and  thir 
teen,  or  ratio  per  one  thousand ' 


1.94 


Patients  in  Asylums. 


Private. 

Pauper. 

469 

530 

553 

598 

630 

641 

Totals. 


1861  f. 
1864 1. 

186711. 


1,026 
1,151 
1,271 


Calculated  population,  1864 4,091,594 


Proportion  of  insane  under  treatment,  1867,  to  population,  one 
in  three  thousand  two  hundred  and  nineteen,  or  ratio  per  one 
thousand , 


.31 


*  See  Knorlein's  Keport  of  Asylum  at  Linz,  published  in  1866,  p.  78. 
t  Helso  och  Sjukvarden,  1861,  pp.  30,  31. 
X  Helso  och  Sjukvarden,  1864,  pp.  26,  27. 
11  Helso  och  Sjukvarden,  1867,  pp.  14,  15. 


4 


[N'uniber  of  insane  in  asylums  and  Houses  for  the  Insane,  January' 

1st,  1864 

Admitted  during  the  year 

Cured  and  imj)roved 

Died 

Number  treated 

Number  January  1st,  1865 


1,095 

332 

163 

91 

1,427 

1,151 


Per  cent  of  cured  and  improved  on  admissions 

Per  cent  of  cured  and  improved  on  number  treated. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated 


49 
11 

27 
6 


Proportion  of  insane  (under  treatment)  to  population,  one  in  three 

thousand  five  hundred  and  fifty-four,  or  ratio  per  one  thousand.!    .28 


Annual  cost  per  head,  three  hundred  and  twenty-eight  rix  dollars  and 
seventy-nine  ore  (three  hundred  and  forty-seven  dollars  and  sixty-eight 
cents,  nearly),  averaging  six  dollars  and  sixty-eight  cents  per  week. 


According  to  the  census  of  1855  the  population  was 3,641,011 

Number  of  insane I  3,893 

Proj^ortion  to  population,  one  in  nine  hundred  and  thirty -five,' 

or  ratio  per  one  thousand I  1.06 


INSANITY   IN    NORWAY. 


Population,  1864 

1,6 

68,254 

Number  of  patients  in  asylums  January  Ist,  1864 

Admitted 

557 
394 

Cured 

124 

Died 

35 

Number  treated  in  1864 

951 

Number  in  asylums  January  1st,  1865 

• 

583 

Per  cent  of  recoveries  on  admissions 

Per  cent  of  recoveries  on  number  treated. 

Per  cent  of  deaths  on  admissions '. 

Per  cent  of  deaths  on  number  treated 


31 

13 

8 

3 


27 


Proportion  of  insane  (in  asylums)  to  population,  one  in  two  thou- 
sand eight  hundred  and  sixty-one,  or  ratio  per  one  thousand .,..1    .34 


Kumber  of  asylums. 


According  to  census  of  1855  the  population  was 

Total  number  of  insane 

Proportion  to  population,  one  in  eleven  hundred  and  twenty - 
one,  or  ratio  per  one  thousand 


1,490,047 
1,329 

.89 


Doctor  Bucknill,  in  eighteen  hundred  and  fifty-seven,  reckons  the  pro- 
portion of  insane  to  the  population  as  one  in  five  hundred  and  fifty-one. 


Kumber  of  asylums  in  1867 


Number  of  patients  in  asylums  January  Ist,  1867. 
Admitted 


Cured 


Died 

Number  treated 

Number  in  asylums  January  1st,  1868. 


Per  cent  of  recoveries  on  admissions 

Per  cent  of  recoveries  on  number  treated. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated 


667 
423 
140 
41 
1,090 
727 


33 

12 

9 

3 


INSANITY   IN    NEW    SOUTH    WALES. 

Population,  1867 447,620 


Number  of  insane,  including  idiots 

Proportion    of   insane  to  population,  one  in   three  hundred  and 
eighty-seven,  or  ratio  per  one  thousand 


1,156 
2.58 


The  number  of   lunatics  under  treatment,  exclusive  of   invalids,  in 
eighteen  hundred  and  sixty-eight,  was: 


28 


Pauper.  Private, 

I 


Totals. 


At  Tarban 

At  Parramatta. 


397        223 

347    I    189 


Totals. 


'44    I    412 


620 
536 


1,156 


In  eighteen  hundred  and  fifty-five  the  number  of  lunatics  in  the  Gov- 
ernment Asylums  was: 


At  Tarban 

At  Parramatta. 


Total. 


197 
279- 

476 


In  eighteen  hundred  and  sixty-eight  the  number  was  eleven  hundred 
and  fifty-six,  an  increase  of  six  hundred  and  eighty  in  thirteen  years,  or 
an  annual  increase  of  fifty-two  and  four  one  hundredths. 

The  cost  of  maintenance  is:  at  Tarban,  seven  shillings  and  eight  pence; 
at  Parramatta,  eight  shillings  and  five  pence. 


INSANITY  IN  THE  UNITED  STATES. 

Population,  1870 38,555,983 

Number  of  Insane. 


White 

35.560 

Elack 

i;605 
169 

Mulatto 

Chinese 

35 

Indian 

13 

Total 

37,382 

Number  of  Idiots. 

White 

21.324 

Black -. 

2J43 

Mulatto 

445 

Chinese 

k 

Indian 

10 

Total 

24,527 

Number  of  insane  and  idiots 61,909 


29 


Proportion  of  insane  to  population,  one  in  ten  hundred  and  thirty- 
one,  or  ratio  per  one  thousand 

Proportion  of  idiots  to  popuhition,  one  in  fifteen  hundred  and  sev- 
enty-two, or  ratio  per  one  thousand 

Proportion  of  insane  and  idiots  to  popuhition,  one  in  six  hundred 
and  twenty -three,  or  ratio  per  one  thousand 


.97 

.63 

1.06 


iS"umber  of  insane  under  treatment.* 

Proportion  of  insane  under  treatment  to  population,  one  in  two 
thousand  one  hundred  and  seventy-three,  or  ratio  per  one 
thousand 


17,735 


.46 


Number  of  patients  in  asylums,  1870  f . 

Admitted  during  the  year  f 

Cured  f •. 

Diedf 

]N"umber  treated  t 


15,792 

10,229 
3,357 
1,851 

26,021 


Per  cent  of  cures  on  admissions 

Per  cent  of  cures  on  number  treated.. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated. 


33 
13 

18 

7 


Number  of  Asylums. 


Public  Asylums.. 
Private  Asylums 

Total 


50 
16 

m 


The  principal  assigned  causes  of  insanity:  ill  health,  spermatorrhoea, 
intemperance,  domestic  trouble,  j^hy^i^'^l  disease,  religious  excitement, 
epilepsy. 

Principal  causes  of  death:  exhaustion  (from  various  causes),  e2:)ilepsy, 
general  paralysis,  and  consumption. 


*  As  nearly  as  can  be  ascertained  from  returns. 

t  Report  for  forty -nine  asylums.    Returns  could  not  be  obtained  from  the  others. 


30 


In  thirty-nine  asylums  visited  in  1870,  the  number  resident  was. 

A  dmitted 

Cured 


Died 

Number  treated. 


12,907 
8,639 
3,240 
1,519 

21,504 


Per  cent  of  cures  on  admissions 

Per  cent  of  cures  on  number  treated.. 

Per  cent  of  deaths  on  admissions 

Per  cent  of  deaths  on  number  treated. 


37 
15 
17 

7 


Years. 

Population. 

Insane. 

Idiots. 

Total. 

« 

US 

[Per  ct.  sup'd 
with  hospital 
accommod's. 

1850 

1860 

1870 

23,191,876 
31,443,322 
38,555,983 

15,610 
23,999 
37,382 

15,787       31,397 
18,865  1    42,864 
24,527       61,909 

28 
46 

6e 

4,730 

^^8.500 
17,735 

30.30 
35.42 
47.44 

INSANITY   IN    CALIFORNIA. 

Population,  1870 560,247 

!N"ative  population  !  350,416 

Foreign  j^opulation j  209,831 

Total 560,247 


Number  of  Insane. 


Males. 

Fem'les 

Totals. 

White 

789 
15 

304 
2 

1  09.^ 

Black 

17 

Mulatto  

Chinese 

29 
2 

835 

4 

1 

311 

33 

Indian 

3 

Totals 

1  146 

*  See  Journal  of  Insanity,  Vol.  XVIII,  p#  2. 


31 

Number  of  Idiots. 


Males. 

Fem'les 

Totals. 

White 

48 
2 

1 
4 
1 

56 

29 

77 

Black   

9 

Mulatto 

1 
1 

2 

Chinese 

5 

Indian 

1 

Totals 

31 

87 

Insane  and  Idiots  classified  as  Native  arid  Foreign. 


Insane. 

Idiots. 

Totals. 

Native 

408 
738 

1,146 

70 
17 

87 

478 

I^oreiffn 

755 

Totals  

1,233 

Proportion  of  insane  to  population,  one  in  four  hundred  and  eighty- 
nine,  or  ratio  per  one  thousand 

Proportion  of  idiots  to  population,  one  in  six  thousand  four  hun- 
dred and  thirty-nine,  or  ratio  per  one  thousand 

Proportion  of  insane  and  idiots  to  population,  one  in  four  hundred 
and  fifty-four,  or  ratio  per  one  thousand 


2.04 

.15 

2.20 


Number  of  insane  under  treatment 

Proportion  under  treatment  to  population,  one  in  five  hundred 
and  thirty-five,  or  ratio  per  one  thousand 


1,047 
1.86 


Proportion  of  native  to  total  insane... 
Proportion  of  foreign  to  total  insane.. 

Total 


35.60 
64.40 

100.00 


32 


Number  of  patients  in  Asylum  January  1st,  1870 

Admitted  during  the  year 

Cured 

Died 

Number  treated 


920 
562 
221 
156 
1,483 


Of  the  whole  number  of  insane,  ninety-one  and  three  tenths  per  cent 
are  under  treatment. 


CHAPTEE   ly. 


CAUSES  OF  INSANITY,  AND  SOME  OF  THE  INFLUENCES  OPEEATING 
IN  ITS  DEVELOPMENT. 

General  Observations — Assigned  Causes — Phj'sical  Causes — Moral  Causes — Observations 
upon  Assigned  Causes — Principal  Assigned  Causes— Insanity  Found  in  all  Countries — 
Enumeration  of  the  Insane— Tables  Kelating  to  Enumeration— Enumerations  Imper- 
fect— -Difficulties  in  the  way  of  a  Perfect  Enumeration — Influence  of  Age — Influence  of 
Age  in  the  Ditferent  Races — Influence  of  Sex — Influence  of  Marriage. 

GENERAL   OBSERVATIONS. 

From  the  formidable  array  made  by  such  an  army  of  insane  men  and 
women,  as  it  is  seen  with  its  banners  flying  in  every  civilized  country,  it 
behooves  us  to  pause  and  give  it  thought;  to  ascertain  as  nearly  as  may 
be  what  causes  are  most  prolific  in  its  production;  what  conditions  of 
society  most  readily  lead  to  its  development,  and  how  best  to  meet  its 
attacks  and  arrest  its  onward  march,  "more  terrible  than  an  army  of 
banners."  Let  us  first  inquire  into  the  causes  producing  this  malady. 
In  ancient  times  insanity  was  attributed  to  supernatural  causes,  but  as 
science  advanced  and  shed  its  light  upon  the  human  race  this  suj^ersti- 
tion  passed  away,  until  at  the  present  time  the  causes  which  lead  to  it 
are  known  to  be  as  varied  as  those  which  affect  the  physical  system,  as 
w^ill  be  seen  from  the  following  table,  taken  from  a  paper  on  the  supposed 
increase  of  insanity,  read  before  the  Association  of  Medical  Superinten- 
dents of  American  Institutions  for  the  Insane,  by  Dr.  Jarvis,  of  Massa- 
chusetts, at  their  annual  meeting  at  Philadelphia,  May,  eighteen  hundred 
and  fifty-one: 

ASSIGNED   CAUSES    OF   INSANITY. 


Physical  Causes. 

Congestion  of  the  brain. 

Disease  of  the  brain. 

Phroenitis. 

Epilepsy. 

Arachnoiditis. 

Apoplexy. 

Convulsions. 

Hydrocephalus. 

Nervous  irritation. 


Moral  Causes. 

Mental  labor  and  excitement. 
Mental  fatigue. 
Mental  shock. 
Mental  perplexity. 
Excessive  study. 
Study  of  metaphysics. 
Study  of  phrenology. 
Excitement  of  lawsuits 
Politics. 


33 


Physical  Causes. 

Excessive  pain. 

Neuralgia. 

Typhus  fever. 

Nervous  fever. 

Bilious  fever. 

Scarlet  fever. 

Intermittent  fever. 

Yellow  fever. 

Gastritis. 

Measles. 

Gout. 

Dyspepsia. 

Dysentery. 

Erysipelas. 

Phthisis. 

Eheumatism. 

Bilious  rheumatism. 

Suppression  of  hemorrhoids. 

Suppression  of  perspiration. 

Suppression  of  secretions. 

Suppression  of  eruption. 

Suppression  of  tumor. 

Suppression  of  fistula. 

Smallpox. 

Yarioloid. 

Irritation  of  the  spine. 

Disease  of  the  spine. 

Ill  health. 

Ill  health  and  solitude. 

Ill  health  and  perplexity  in  busi- 
ness. 

Ill  health  and  family  trouble. 

Ill  health  and  pecuniary  difficulties. 

Ill  health  and  lawsuit. 

Old  age. 

Irregular  decay  of  powers  in  old 
age. 

Congenital. 

Hereditary. 

Injuries. 

Concussion  of  brain. 

Lesion  Of  brain. 

Blow  on  the  head. 

Fracture  of  the  head. 

Burn  on  the  head. 

Malformed  head. 

Fall. 

Kick  on  the  stomach. 

Surgical  operation. 

Mesmerism. 

Insolation. 

Want  of  exercise. 
5 


Moral  Causes. 

Political  commotions. 

Excitement  of  Mexican  war. 

Excitement  of  visiting. 

Sea  voyage. 

License  question. 

Anti-rent. 

Fourierism. 

Preaching  sixteen  days  and  nights. 

Blowing  fife  all  night. 

Application  to  business. 

Eeading  vile  books. 

Seclusion. 

Sudden  joy. 

Hope. 

Faulty  education. 

Day  dreaming. 

Extatic  admiration  of  works  of  art. 

Seduction. 

Domestic  affliction. 

Domestic  trouble. 

Family  affairs. 

Bad  conduct  of  children. 

Ill  treatment. 

Ill  treatment  from  husband. 

Ill  treatment  from  parents. 

Abuse  from  husband. 

Infidelity  of  husband. 

Infidelity  of  wife. 

False  accusation. 

Imprisonment  for  crime. 

Difficulty  in  neighborhood. 

Avarice. 

Anticipation  of  wealth. 

Speculation  in  stocks. 

Speculation  in  morus  multicaulis. 

Speculation  in  lottery  tickets. 

Perplexity  in  business. 

Pecuniary  difficulties. 

Disappointment  in  business. 

Loss  of  money. 

Loss  of  property. 

Eeverse  of  fortune. 

Fear  of  poverty. 

Death  of  relations. 

Death  of  husband. 

Death  of  father. 

Death  of  son. 

Sickness  and  death  of  a  friend. 

Sickness  and  death  of  friends. 

Sickness  and  death  of  kindred. 

Murder  of  a  son. 

Anxiety. 


34 


Physical  Causes. 

Sedentary  habits. 

Idleness. 

Insolation  and  drinking  cold  water. 

Exposure  to  excessive  heat. 

ExjDosure  to  cold. 

Bathing  in  cold  water. 

Sleeping  in  a  barn  filled  with  new 

hay. 
Tight  lacing. 
Excess  of  quinine. 
Metallic  vapor. 
Prussic  acid  vapor. 
Charcoal  vapor. 
Pregnancy. 
Parturition. 
Abortion. 
Puerperal. 
Cold  in  childbed. 
Lactation. 

Sexual  derange.ment. 
Disease  of  uterus. 
Irregular  menstruation. 
Profuse  menstruation. 
Suspended  menstruation  at  change 

of  life. 
Suppressed  menstruation. 
Hysteria. 
Carbonic  acid  gas. 
Working  in  white  lead. 
Acetate  of  lead. 
Excessive  labor. 
Bodily  exertion. 
Loss  of  sleep. 
Intemperate  use  of  snuff. 
Intemperate  smoking. 
Intemperate  opium  eating. 
Syphilis. 
"Vice. 
Immorality. 


And  winds  up  by  saying:  "These  are  not  all  the  diseases,  accidents, 
events,  etc.,  that  can  d^isturb  the  regular  action  of  the  brain." 

OBSERVATIONS   UPON   ASSIGNED   CAUSES. 

From  this  formidable  list  of  assigned  causes  of  mental  disturbance  we 
see  there  is  scarcely  a  disease  of  the  body,  an  emotion  of  the  mind,  or  a 
feeling  of  the  heart  that  may  not  act  as  an  exciting,  if  not  an  actual 
cause  in  the  dethronement  of  man's  reason.  "  Dr.  Ludwig,  of  the  Hep- 
penheim  Asylum,  expressed  the  opinion  that  the  cause  of  insanity  is 
extremely  obscure  and  not  easily  defined,  and  thinks  that  most  of  the 
assigned  causes  are  made  at  the  writing  desk  of  the  Committing  Boards ; 


Moral  Causes. 

Anxiety  and  loss  of  sleep. 
Anxiety  for  absent  friends. 
Home  sickness. 
Fright. 

Disappointment. 
Disappointment  in  love. 
Disappointment  in  ambition. 
Unrequited  love. 
Want  of  employment. 
Want  of  occupation. 
Destitution. 
Mortified  pride. 
Ungoverned  passion. 
Virulent  temper. 
Misanthropy. 
Jealousy. 
Envy. 
Duel. 

Eeligious  anxiety. 
Eeligious  excitement. 
Eemorse. 
Millerism. 
Mormonism. 

Struggle  between  the  religious  prin- 
ciple and  power  of  passion. 
Epidemic  influences. 


35 

that  predisposition  must  exist,  and  that  the  form  is  only  the  effect,  not 
the  cause."  AVe  very  well  know  that  mistakes  are  often  made  by  Com- 
mitting Boards,  even  when  composed  of  physicians,  and  that  symptoms 
are  too  often  mistaken  for  disease ;  nevertheless  we  cannot  agree  with 
Pr.  Ludwig  and  other  German  Superintendents  who  assign  nearly  all 
cases  of  lunacy  to  hereditary  taint.  Intemperance  was  admitted  by  a  few 
of  those  with  whom  we  conversed  to  be  a  cause  of  mental  disturbance, 
but  all  others  were  set  aside  as  unworthy  of  being  assigned  a  place. 
Dr.  Koeppe,  the  intelligent  Director  and  Physician  in  Chief  of  the  cele- 
brated Asylum  at  Halle,  in  Prussian  Saxony,  informed  us  that  eighty 
per  cent  of  those  committed  to  his  Asylum  were  from  hereditary  causes, 
and  that  this  was  in  accord  with  the  experience  of  the  Superintendents 
of  other  institutions  in  Germany.  To  say  the  least,  this  does  not  agree 
with  the  opinions  of  the  learned  and  practical  men  who  have  charge  of 
Asylums  in  most  other  countries,  and  especially  in  Great  Britain  and  the 
United  States. 

The  preceding  list  was  inserted  as  a  matter  of  general  interest.     The 
following  table  comprises  the  principal  assigned  causes  of  insanity: 


36 


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:    : 

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37 

INSANITY   FOUND   IN   ALL   COUNTRIES. 

As  the  causes  enumerated  in  this  Chapter  operate  with  more  or  less 
power  and  energ}^  in  producing  insanity,  we  learn  that  it  is  found  in  all 
countries  and  among  all  nations,  but  is  more  prevalent  among  civilized 
than  among  savage  people.  It  is  true  that  we  have  no  statistical  data 
upon  which  to  predicate  this  assertion,  as  *no  census  of  the  insane  has 
ever  been  taken  in  savage  or  semi-barbarous  nations.  From  those  who 
have  resided  in  these  countries,  and  from  travellers  who  have  gone 
among  them,  we  learn  that  but  little  insanity  is  known  among  them. 
Caleb  Cushing,  former  United  States  Minister,  states  that  after  a  some- 
what protracted  residence  in  China  he  had  concluded  there  were  but  few 
lunatics  to  be  seen  or  heard  of.  Mr.  AYilliams,  an  American  missionary, 
after  a  residence  of  twelve  years,  says  that  he  only  saw  two  who  were 
''  upside  down,"  as  the  Chinese  call  it,  during  the  whole  time. 

All  travellers  agree  that  it  scarcely  exists  in  Nubia,  and  that  it  is 
extremely  rare  in  Egypt.  In  eighteen  hundred  and  forty-four,  according 
to  a  statement  in  the  London  Medical  Gazette,  there  were  only  fourteen 
in  Cairo,  being  one  to  twenty-three  thousand  five  hundred  and  seventy- 
two  of  the  population.  A  few  isolated  cases  have  been  reported  by 
Doctors  Moreau  and  Furnari,  among  the  tribes  bordering  on  the  African 
shores  of  the  Mediterranean,  but  agree  in  the  general  conclusion  as  to  its 
scarcity.  Doctor  Furnari  thinks  it  is  in  consequence  of  their  "total 
abstinence." 

Doctor  De  Forest,  of  the  Syrian  Mission,  in  a  letter  to  Doctor  Butler, 
of  America,  says:  "It  is  impossible  to  obtain  accurate  statistics  of  the 
insane  here,  but  I  think  the  disease  far  less  frequent  than  in  our  own 
land."  He  gives  a  fearful  picture  of  the  treatment  of  those  who  are 
unfortunate  enough  to  be  insane.  Doctor  Paulding,  in  the  Boston  Medi- 
cal and  Surgical  Journal  (1852),  bears  testimony  to  the  same  facts. 

Doctor  Wise,  Superintendent  of  an  asylum  in  Bengal,  states  as  the 
result  of  his  experience,  "that  insanity  is  less  frequent  and  assumes  a 
less  acute  form  among  the  East  Indians  than  among  the  civilized  nations 
of  Europe."  Cajitain  Wilkes,  of  the  United  States  Exploring  Expedi- 
tion, in  a  letter  to  Doctor  Brigham,  says:  "During  the  whole  of  my 
intercourse  with  the  natives  of  the  South  Sea  I  met  no  deranged  person. 
I  am  confident  that  had  any  instance  of  mental  derangement  among  the 
natives  occurred,  it  would  have  been  observed  by  us." 

We  all  know  in  this  country  that  for  a  long  time  it  was  supposed  that 
no  Indian  had  been  known  to  become  insane;  and  so  we  might  show  of 
all  other  countries  where  savages  are  found  in  similar  conditions,  if 
deemed  important.  That  it  exists  in  much  larger  proportions  in  Europe 
and  America  scarce  needs  be  stated,  as  it  is  a  fact  well  known  to  all  who 
have  paid  the  least  attention  to  the  subject,  and  will  be  abundantly 
proved  in  this  report.  That  it  is  not  due  to  any  peculiarity  of  race  will 
also  be  shown,  at  least  with  regard  to  some  of  these  peoples,  when 
brought  in  contact  with  more  civilized  nations  and  subjected  to  the 
influences  by  which  it  is  developed. 

It  is  believed  to  be  due  to  causes  inherent  in  man,  or  connected  with 
his  condition,  habits,  and  exposures. 

Some  of  these  causes  belong  to  the  body,  as  physical  diseases — 
apoplexy,  epilepsy,  palsy,  scrofula,  injuries  to  the  head,  general  ill  health, 
consumption — and  some  are  called  moral  causes,  such  as  anxiety,  exces- 
sive study,  grief,  remorse,  distress,  struggles  for  gain,  ambition.  Some 
of  these  causes  apply  to  the  savage  as  well  as  civilized  nations,  while 


38 


others  are  applicable  exclusively,  or  nearly  so,  to  a  condition  of  civili- 
zation. They  vary  m  their  frequency,  intensity,  and  power,  and  conse- 
quently the  mental  diseases  also  differ  in  frequency  and  durability:  to 
what  extent  we  will  endeavor  to  show,  in  a  measure  at  least,  hereafter 

I:^lV,Z^^^^^  ^^'^'^*  ^^^^^  ^^-^^-^  ^^-^  '^^P-^^ose 

ENUMERATION   OF   THE   INSANE. 

w?^''^;$  f^*-''"^  in  their  enumerations  take  account  of  the  insane:  thus 
we  find  their  numbers  as  seen  in  the  following  tables: 


39 

Table 


O 

1 

o 

Population. 

Numbers  of  Insane 
and  Idiots. 

Proportion  of— 

COUNTRY. 

Insane 

Idiots.     Total. 

Insane  to 
Popula- 
tion. 

Idiots  to 
Popula- 
tion. 

Total  to 
Popula- 
tion. 

United  States 
England 

1870 

1870 
1870 
1870 
1866 
1867 
1865 

38,555,983 
22,090,163 
3,222,837 
*  5,195,236 
37,988,905 
23,971,337 

37,382 

24,527 

61,909 
54  713 

1  in  1,031 

1  in  1,572 

1  in  623 
1  in  403 

9,571 
17,194 
90,679 
37,960 

1  in  336 

Ireland 

France 

Prussia 

11,122 

50,726 
16,929 

6,072 
39,953 
21,031 

1  in     467 
1  in     747 
1  in  1,416 

1  in     855 
1  in     950 
1  in  1.139 

1  in  302 
1  in  418 
1  in  (81 

Belgium 

4,984,451 

7,431 

1  in  671 



Total 

136,008,912 

279,457 

...' 

1  in  486 

1 

Table. t 


Countries. 


Census  ta- 
ken once 
in  : 


Populat'n. 


Number  of  Insane. 


Males. 


FemPs 


Totals. 


Proport'n 

to 
Populat'n 


Ireland  

England  and  Wales 

Newfoundland  

Nova  Scotia 

Prince  Edward's  Island. 

United  States  

France   

Savoy 

Belgium 


Holland 

Hanover 

Prussia  

Saxony  

Bavaria 

Wurtemburg 

Hesse  Darmstadt 

Oldenburg  

Denmark 

Sweden  

Norway  

Piedmont 


10  years 

10  years 

10  years 

10  years 

7  years 

10  years 

5  years 

4  years 

10  years 

10  years 

3  years 

3  years 

3  years 

3  years 

3  years 

3  years 


5  years 

5  years 

10  years 

10  years 


1861 
1861 
1857 
1861 
18B1 
1860 
1856 
1861 
1856 
1859 
1861 
1858 
1861 
1861 
18G1 
1861 
1855 
1860 
1855 
1855 
1858 


5,798,967 

20,066,224 

122,638 

330,857 

80,857 

31,445,080 

36,012,669 

542,535 

4,529,560 

3,308,969 

1,888,048 

17,739,913 

2,225,240 

4,689,837 

1,720,708 

856,907 

287,103 

2,605,024 

3,641,011 

1,490,047 

5,041,853 


3,500 

11,249 

50 

166 


143 

2,019 
1,038 
1,591 


2,576 
690 


446 
2,543 

1,898 
619 


3,565 

13,096 

38 

174 


167 
1,998 
1,101 
1,493 


7,065 

24,345 

88 

340 

148 

23,999 

35,031 

810 

4,017 

2,139 

3,084 


1  in  821 
lin  824 
1  in  1,394 
1  in  973 
1  in  546 
1  in  1,310 
1  in  1,028 
1  in  1,750 
1  in  1,128 
1  in  1,547 
1  in  612 


i    1,559 

2,323  I    4,899 
648  I    1,338 


1  in  1,427 
1  in  957 
1  in  1,286 


508 
2,592 
1,995 

710 


954 
5,135 
3,893 
1,329 
1,750 


1  in  301 
1  in  507 
1  in  935 
1  in  1,121 
1  in  2,881 


*  Calculated  population. 

t  From  Vital  Statistics  of  Ireland. 


40 
Table. 


Countries. 


Spain 

Italy 

Belgium  

Holland 

France 

United  States. 
Malta  &  Gozzo 
Westphalia... 

England  

Ireland 

Scotland  

Norway 

Brunswick 


Cities. 

London 

Paris 

Petersburg 

Naples  

Cairo  

Madrid 

Eome  

Milan 

Turin  

Plorence 

Dresden 

Brunswick.. 


1844.-^ 


Population 


4,058,000 

16,789,000 

3,816,000 

2,.302,000 

32,000,000 

17,069,453 

120,000 

1,283,142 

13,089,358 

7,784,536 

2,365,807 

1,051,300 

262,948 


1,400,000 

890,000 

377,000 

370,000 

330,000 

204,000 

154,000 

151,000 

114,000 

80,000 

70,000 

37,583 


Insane. 


569 

3,441 

3,763 

2,300 

32,000 

17,457 

130 

1,535 

16,222 

10,059 

3,652 

1,909 


7,000 

4,000 

120 

479 

14 

60 

320 

618 

331 

236 

150 

104 


1  in  7,180 
1  in  4,876 
1  in  1,014 
1  in  1,001 
1  in  1,000 
1  in 


lin 
lin 
lin 
lin 
lin 
lin 
lin 


932 
846 
807 
774 
648 
551 
539 


1  in  200 
1  in  222 
1  in  3,142 
1  in  772 
1 :  23,572 
1  in  3,400 
1  in     480 


lin 
lin 
lin 
lin 
lin 


244 
341 
339 
446 
361M 


1850.t  1857.$ 


Eatio.  Eatio. 


Eatio. 


1  in  7,181 
1  in  3,785 


1  m  1,000 


1  in     666 


lin 
lin 


400 
531 


1  in  795 


1  in  577 
1  in  551 


1860.1 


Eatio. 


1  in  1,667 
1  in  3,690 
1  in  816 
1  in  1,223 
1  in  1,773 


1  in  700 
1  in  2,125 
1  in  513 
1  in     550 


1867.1 


Eatio. 


1  in  444 


1  in  432 
1  in  325 
1  in  368 


ENUMERATIONS    IMPERFECT. 

These  statements  of  the  insane  are  doubtless  imperfect  in  all  countries, 
and  certainly  very  imperfect  in  some  of  them.  It  is  impossible  to  obtain 
full  accounts  of  the  insane  through  public  offices  as  at  present  organ- 
ized, and  any  other  and  more  perfect  system  would  probably  be  deemed 
too  expensive  by  most  Governments.  We  have  reason  to  believe  that 
many  are  concealed  from  public  view,  and  that  families  refuse  to  report 
them  to  ordinary  officers. 

DIFFICULTIES   IN    THE   WAY    OF   PERFECT    ENUMERATION. 

Massachusetts  seems  to  have  understood  and  appreciated  these  diffi- 
culties at  an  early  date,  and  in  eighteen  hundred  and  fifty-four 
appointed  a  Commission,  consisting  of  Levi  Lincoln,  Doctor  Edward 
Jarvis,  and  Increase  Sumner,  to  ascertain  the  number  and  condition  of 


*  See  London  Medical  Gazette,  April,  1844. 

t  American  Journal  of  Insanity,  Vol.  YII,  p.  286. 

J  Bucknill  &  Tuke  on  Insanity,  p.  47. 

§  Journal  of  Insanity,  Vol.  XVII,  p.  348. 

U  Manning's  Eeports,  p.  109. 


41 

the  insane  in  the  State;  distinguishing  as  accurately  as  may  be  between 
the  insane,  i^roperly  so  considered,  and  the  idiotic  or  non  compos;  between 
the  furious  and  harmless;  curable  and  incurable;  and  between  the 
natives  and  foreigners,  and  the  number  of  each  who  are  State  paupers. 
(See  Insane  and  Idiots,  Mass.  1854). 

This  Commission  addressed  circulars  to  every  j^hysician  in  the  State, 
setting  forth  the  facts  that  they  desired  to  obtain,  and  asking  their 
assistance  and  cooperation.  There  were  at  that  time  fifteen  hundred 
and  fifty-six  physicians  in  the  State,  of  whom  all  but  four  responded, 
giving  every  case  within  their  knowledge. 

Besides  these,  many  of  the  clergy,  Overseers  of  the  Poor,  and  other 
persons  known  or  supposed  to  be  interested  in  or  informed  upon  the 
subject  were  consulted  and  their  assistance  asked. 

After  twelve  months  of  constant,  persistent,  and  untiring  labor  the 
most  comj^lete,  able,  and  satisfactory  report  ever  made  of  the  insane  and 
idiots  in  any  State  or  country  was  the  result.  It  Avas  not  only  impor- 
tant to  Massachusetts,  but  to  all  other  States  and  countries.  The  subject 
of  inquiry  was  of  a  general  character,  and  the  facts  found  and  infer- 
ences deduced  as  applicable  to  all  the  world  as  to  Massachusetts. 

Without  going  into  the  details  of  the  modus  operandi  by  which  the 
information  was  obtained,  it  is  sufficient  to  state  the  result  in  a  few  par- 
ticulars. Of  the  lunatics  found,  fifteen  hundred  and  twenty-two  were 
paupers,  and  eleven  hundred  and  ten  were  supported  by  their  own  prop- 
erty or  by  their  friends,  making  a  total  of  two  thousand  six  hundred 
and  thirty-two,  or  one  to  every  four  hundred  and  twenty-seven  of  the 
population;  whereas  an  enumeration  made  by  another  Commission,  in  a 
different  way,  a  few  years  previously  (eighteen  hundred  and  forty-eight), 
showed  only  one  to  five  hundred  and  ninety-two  of  the  population.  The 
United  States  census  of  eighteen  hundred  and  sixty  showed  one  to  five 
hundred  and  eighty-five,  and  in  eighteen  hundred  and  seventy,  one  to 
five  hundred  and  forty-seven.  These  figures  demonstrate  the  imperfec- 
tions of  general  enumerations,  and  the  difference  exhibited  by  a  census 
perfectly  taken.  This  difference,  we  think,  may  safely  be  added  to  the 
enumerations  made  in  other  countries. 

INFLUENCE   OP   AGE. 

Among  the  causes  of  insanity,  age  is  supposed  to  have  its  influence; 
at  all  events,  it  is  a  fact  established  by  the  observations  of  most  men 
who  have  written  upon  the  subject  that  a  larger  proj^ortion  become 
insane  between  the  ages  of  thirty  and  forty  than  at  any  other  period  of 
life.  The  general  enumerations  of  the  insane  do  not  show  their  ages, 
but  this  is  stated  in  all  those  who  are  committed  to  hospitals,  and  thus 
the  deficiency  is  in  a  measure  supplied,  and  we  are  thereby  enabled  to 
arrive  at  approximate  conclusions. 

There  are,  however,  some  notable  exceptions  to  this  general  rule. 
The  experience  of  Esquirol  at  Charenton  showed  the  largest  number  of 
admissions  between  twenty  and  thirty.  The  experience  of  Doctor  Erie 
at  Bloomingdale,  and  that  of  Doctor  Hood  during  ten  years  at  Bethlem, 
is  in  accord  with  that  of  Esquirol  at  Charenton,  though  the  whole  expe- 
rience of  Esquirol  was  in  accordance  with  the  general  rule,  while  that 
of  Doctor  Tuke  was  in  favor  of  the  earlier  period,  between  twenty  and 
thirty.     It  will  be  seen  by  the  following  table  that  in  France,  Italy,  and 


42 

Holland  the  greatest  number  become  insane  between  the  ages  of  thirty 
and  forty,  while  in  Ireland  and  at  the  York  Eetreat  the  greater  number 
was  between  twenty  and  thirty.  The  table  also  shows  that  the  numbers 
decrease  as  we  ascend  or  descend  the  scale.  This  result  may  be  attrib- 
uted to  the  fact  that  at  that  period  of  life  both  males  and  females  are 
more  exposed  to  the  various  exciting  causes  than  at  any  other.  It  is 
contended  by  some  authors,  however,  that  the  age  between  thirty-five 
and  forty  exercises  a  special  influence  over  the  production  of  insanity; 
but  of  this  we  have  no  other  evidence  than  that  already  cited.  The  fol- 
lowing table  will  show  the  influence  of  age,  illustrated  by  statistics  of 
different  countries: 

Table. 

Influence  of  Age,  illustrated  by  Statistics  of  Different  Countries. 


France. 
1853. 

Ireland. 

District  Asy- 
lums, 1870. 

Italy. 

Florence 

Holland. 
1844  to  1864. 

Total. 

^ 

^ 

i^ 

hi 

^ 

hi 

t^ 

»TJ 

"A 

^ 

AGE. 

1 

a 

B 

CD 

II 

B        ^ 

i| 

II 

c  3- 

c  o 

ri-  O 

r+O 

^5 

o  := 

C    3 

op 

0   ^ 

S^!3 

<    SS 

^   SS 

fo 

» 

O   P 

.'^P 

■^p 

^   '^ 

-  rt) 

-,  ^ 

:     <n- 

:2  o 

eg  o 

J<5   O 

•          /T> 

S  ^ 

g   ^ 

•          P 

p 

a:}   XT 

o 

■    o 

:    c 

:   cf 

tr 

"  O 

Under  10  years  "1 
10  to  20  years...  J 

1,809 

5.90 

1      2 
1  187 

.08 
8.14 

3 

18 

.96 
5.73 

66 
653 

.56 
5.57 

}  2,738 

6.08 

20  to  30  years 

5,912 

19.27 

713 

31.05 

68 

21.66 

2,681     2 

2.87 

9,374 

20.83 

30  to  40  years 

8,470 

27.61 

593 

25.83 

77 

24.52 

3,045     2 

5.98 

12,185 

27.08 

40  to  50  years 

7,011 

22.86 

374 

16.29 

66 

21.02 

2,370     2 

0.22 

9,821 

21.82 

50  to  60  years 

4,610 

15.03 

229 

10.00 

41 

13.06 

1,672     1 

4.27 

6,552 

14.56 

60  to  70  years 

2,022 

6.59 

145 

6.31 

24 

7.64 

867 

7.40 

3,058 

6.79 

Over  70  years 

839 

2.74 

53 

2.30 

17 

5.41 

367 

3.13 

1,276 

2.84 

Unknown 

2,203 

37 

2,240 

"'•■ \" 

. ........ 

Totals 

32  876' 

2,333 

314  i 

11  791  L. 

47.244 

1 

Doctor  Tuke  says:  "During  the  forty  four  years  between  seventeen 
hundred  and  ninety-six  and  eighteen  hundred  and  forty,  of  those 
admitted  at  the  Eetreat  "the  greater  number  (one  third  of  the  whole) 
were  attacked  between  twenty  and  thirty  years  of  age.  Each  subsequent 
decennial  period  is  marked  by  a  gradually  decreasing  proportion.  Thus, 
of  every  hundred  cases  at  the  origin  of  the  disorder  there  were,  at  suc- 
cessive periods  of  life,  as  follows: 


0-10 

10-20 

20-30 

30-40 

40-50          50-60 

60-70 

70-80 

80-90 

.96 

12.77 

32.53 

20.00 

15.9            10.6 

6.3 

.97 

.24 

43 

"  Now  it  is  obvious  that  to  render  these  statistics  of  any  value  they 
must  be  compared  with  the  numbers  living  in  the  same  community  at 
the  same  periods  of  life.  This  means  of  comparison  we  afford  in  the 
following  table. 

<'  Of  every  hundred  individuals  there  were  living,  at  successive  decen- 
nial periods  of  life,  as  follows: 


0-10 

10-20 

20-30 

30-40 

40-50 

50-60 

60-70 

70-80 

80-90 

16.7 

18.9 

15.4 

12.4 

11.9 

10.8 

7.8 

4.9 

1.2 

<'  From  which  it  is  evident  that  the  large  proportion  of  persons  who 
become  insane,  of  those  admitted  at. the  Eetreat,  between  twenty  and 
thirty  years  of  age,  cannot  be  explained  by  the  greater  proportion  of 
the  number  living  at  that  period.  On  the  contrary,  there  were  more 
living  under  ten  years  of  age  and  between  ten  and  twenty.  These  facts, 
therefore,  exhibit  an  mcreased  liability  to  insanity  connected  with  the 
age  between  twenty  and  thirty;  or  man  during  that  period  is  brought 
into  contact  with  an  increased  number  of  the  causes  of  insanity.  It  is 
probable  that  it  is  the  combination  of  these  two  circumstances  which 
induces  this  result."* 

In  eighteen  hundred  and  fifty  the  greatest  number  of  inhabitants  of  a 
given  age  in  the  United  States  was  under  ten,  the  next  greatest  between 
ten  and  twenty,  and  so  on,  gradually  decreasing  to  the  end.  We  pre- 
sume that  these  proportions  have  been  maintained  to  the  present  time; 
and  as  we  have  not  by  us  any  census  of  a  later  date  setting  forth  this 
particular  fact,  we  have  made  use  of  it  in  preparing  the  following  table, 
taking,  however,  the  number  of  insane  for  eighteen  hundred  and  seventy 
instead  of  eighteen  hundred  and  fifty,  and  leaving  idiots  out  of  the  com- 
putation. From  this  it  will  be  seen  that  though  there  are  many  more 
persons  living  under  ten,  between  ten  and  twenty,  and  between  twenty 
and  thirty,  than  between  thirty  and  forty,  still  the  number  of  insane  of 
the  latter  age  are  greatly  in  excess  of  those  of  any  other  age. 


*  See  Bucknill  &  Tuke  on  Insanity,  p.  245. 


44 
Table. 

Influence  of  Age  illustrated  by  Statistics  of  the   United  States. 


AGE. 

Population 

No.  Insane,  1870. 

Proportion  at  each 

age  to  total  of 
known  ages. 

Popula'n 

No.Ins'e 

Under  ten  years 

6,739,041 
5,420,421 
4,277,318 

2,825,819 

1,846,660 

1,109,540 

609,926 

257,234 

77,382 

11,695 

2,555 

14,285 

324 

1,992 
7,096 
9.109 
7,976 
5,264 
3,307 
1,569 

455 
62 
15 

213 

29.08 

23.38 

18.46 

12.19 

7.97 

4.79 

2.63 

1.11 

.33 

.05 

.01 

.87 
5.36 
19.09 
24.51 
21.46 
14  Ifi 

From  ten  to  twenty  years 

From  twenty  to  thirty  years 

From  thirty  to  forty  years 

From  forty  to  fifty  years 

From  fil^y  to  sixty  years 

Prom  sixty  to  seyenty  years 

From  seyenty  to  eighty  years 

From  eighty  to  ninety  years 

From  ninety  to  one  hundred  years. 
One  hundred  years  and  upwards.. 
Unknown 

8.90 

4.22 

1.22 

.17 

.04 

Totals 

23,191,876 

37,382 

100.00 

100.00 

INFLUENCE    OP   AGE   IN    THE   DIFFERENT   RACES. 

The  following  table  has  been  made  for  the  purpose  of  showing  the 
susceptibility  to  insanity  of  the  different  races  inhabiting  our  continent, 
and  the  ages  at  which  they  are  most  liable  to  the  seizure  of  this  terrible 
malady. 


45 


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46 

The  preceding  table  shows  a  most  interesting  fact,  that  may  or  may 
not  be  overthrown  by  further  investigation  and  longer  experience.  It 
will  be  observed  that  while  the  general  rule  under  discussion  holds  good 
with  the  Chinaman  and  the  Indian,  that  both  the  black  and  mulatto  are 
most  liable  to  become  insane  between  twenty  and  thirty,  and  that  this  is 
true  with  regard  to  both  males  and  females.  This  may  be  the  result  of 
accident;  but  from  our  knowledge  of  the  race,  derived  from  a  long  resi- 
dence among  them  in  the  Southern  States,  we  are  of  the  opinion  it  is  the 
result  of  a  natural  law.  Their  development,  both  intellectual  and  physi- 
cal, is  of  much  earlier  growth  and  maturity  than  that  of  the  Caucasian, 
and  as  insanity  seems  to  attack  the  human  race  most  frequently  at  that 
age  when  all  the  faculties  are  in  fullest  maturity,  and  most  powerful, 
energetic  action,  there  would  seem  to  be  no  reason  why  the  negro  should 
be  au  exception  to  the  general  law.  These  reflections,  however,  are 
made  more  to  direct  the  attention  of  future  investigation  to  the  subject 
than  with  a  view  to  the  promulgation  of  a  new  theory  or  the  enuncia- 
tion of  a  new  idea. 

INFLUENCE   OF   SEX. 

The  susceptibility  of  the  sexes  to  insanity  has  been  a  debateable  ques- 
tion from  the  days  of  Ca?lius  Aurelianus  to  the  present  time,  most  of 
those  participating  in  the  discussion  seeming  to  be  guided  by  their  indi- 
vidual experience  or  their  immediate  surroundings.  Aurelianus,  Pinel, 
Haslam,  and  their  followers  taking  sides  with  the  women,  while  Esqui- 
rol,  Copeland,  Browne,  and  others  took  the  other  side  of  the  question. 
In  our  country.  Doctor  Eush  was  of  the  opinion  that  more  women  were 
insane  from  the  fact  that  they  are  exposed  to  several  exciting  causes 
from  which  men  are  exempt,  apparently  overlooking  another  fact,  that 
men  are  liable  to  many  causes  from  the  influence  of  which  females  are 
partially  or  entirely  removed.  Doctor  Jarvis,  one  of  the  closest  observ- 
ers and  most  thorough  investigators  whose  writings  have  come  under 
our  observation,  came  to  the  conclusion  some  twenty  years  ago,  after 
exhausting  all  the  information  that  existed  on  the  subject  at  that  time, 
that  a  few  more  men  than  women  become  insane.  (Jarvis  on  the  Com- 
parative Liability  of  Males  and  Females  to  Insanity;  see  American  Jour- 
nal of  Insanity,  Vol.  YII,  p.  142.)  And  from  the  following  table  of  first 
admissions  into  the  Asylums  of  England,  Ireland,  France,  Belgium,  Hol- 
land, and  Bavaria,  during  the  period  specified,  it  would  seem  that  the 
conclusion  at  which  he  then  arrived  still  holds  good ;  though  according 
to  the  United  States  census  for  eighteen  hundred  and  seventy  the  reverse 
of  this  would  seem  to  be  true  in  our  country,  as  the  nuniber  of  males 
was  eighteen  thousand  one  hundred  and  seventy-four;  the  number  of 
females,  nineteen  thousand  two  hundred  and  eight,  or  an  excess  of  one 
thousand  and  thirty -four  females. 


47 
Table, 

Shotoing  the  Infiuence  of  Sex. 


COUNTKIES. 

Period. 

Number  of  First  Ad 

missions. 

Males. 

Females. 

Totals. 

England 

1870 

1870 

1853 

1865 
1844  to  1864 
1858  to  1868 

5,124 
1,141 

3,959 

865 

4,747 

388 

4,966 
971 

3,487 
690 

4,526 
324 

10,090 

Ireland 

2  112 

France 

7,447 

Bel  '>'iiini 

1,555 
9,273 

712 

Holknd 

Bavaria  (Asylum  at  Irsee).... 

Totals 

16,224 

14,964 

31,188 

The  various  arguments  made  and  facts  adduced  to  prove  the  one 
theory  or  the  other,  are  conclusive  evidence  to  our  mind  that  there  is 
but  little  difference  in  the  gross  number  of  the  sexes.  As  classes  they 
seem  about  equally  subject  to  this  malady,  yet  different  causes  operate 
in  various  proportions  on  the  sexes.  Men  "are  more  intemperate,  which 
is  well  known  to  be  one  of  the  most  prolific  causes  of  insanity,  its  vic- 
tims being  in  proportion  of  about  four  men  to  one  woman.  More  men 
are  engaged  in  hazardous  enterprises  and  doubtful  business  speculations, 
in  gambling  and  other  dissipation,  more  subject  to  disappointment  and 
failure  in  business  operations,  more  use  their  brains  excessively  in  study, 
in  scientific  investigations  and  ambitious  projects,  and  more  are  liable  to 
ordinary  accidents  and  the  casualties  and  exposures  of  war. 

On  the  contrary,  domestic  trials,  ill  health,  loss  of  relatives,  and  disap- 
pointments in  love  act  more  powerfully  on  women,  while  a  few  other 
causes  belonging  to  peculiarities  of  organism  affect  them  only.  We  must 
conclude,  therefore,  that  the  liability  of  the  excess  to  insanity  is  very 
nearly  equal,  and  that  any  difference  in  numbers  in  different  countries 
and  localities  depends  more  on  the  exposure  to  the  various  causes  that 
produce  it  than  to  difference  of  liability  in  the  sexes;  and  these  must 
vary  with  different  nations,  different  periods  of  the  world,  and  different 
habits  of  the  people.  The  fact  that  the  percentage  of  recoveries  is 
slightly  greatest  among  females,  and  a  fortiori,  the  i3ercentage  of  deaths 
among  males,  is  too  well  established  to  require  an  argument.  The  reason 
of  this  is  obvious;  we  have  already  seen  that  the  causes  operating  on 
the  sexes  are  different  in  some  important  particulars;  general  ill  health 
and  the  puerperal  condition  adding  largely  to  the  list  among  females, 
give  to  insanity  its  most  curable  cases;  while  ej)ilepsy,  palsy,  and  mas- 
turbation are  more  frequent  causes  among  men,  and  are  among  the  most 
incurable  cases. 

INFLUENCE   OF   MARRIAGE. 

The  experience  of  all  writers  upon  the  subject,  as  far  as  our  observa  - 
tion  has  extended,  shows  conclusively  that  a  greater  number  of  single 
than  married  persons  become  insane,  notwithstanding  there  are  more  of 
the  latter  class  of  the  ages  most  subject  to  insanity. 


48 


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Totals... 


Female. 


Male. 


lit- 


P^ 


CO 


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5  CO 


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Totals... 


Female. 


Male. 


Totals... 


Female. 


Male. 


Totals... 


Female. 


Male. 


Totals... 


Female. 


Male. 


Totals... 


Female. 


Male 


oo  ^x 

1^  CO  1--  o 

i-H  Tt<  X  Ci 


T— I  1-H  IC  i-< 
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574 
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2,180 

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49 

From  the  foregoing  table  we  find  that  out  of  every  one  hundred 
patients  whose  civil  condition  was  known,  sixty-one  and  ninety-one  one 
hundredths  were  single,  twenty-nine  and  fifty-eight  one  hundredths  were 
married,  and  eight  and  fifty-one  one  hundredths  were  widowed. 

It  aj^pears  from  the  census  of  eighteen  hundred  and  fifty-one  that 
the  condition  of  the  entire  population  of  Great  Britain  (aged  twenty 
and  upwards)  was  in  respect  of  marriage  as  follows:  * 


Unmarried. 

Married. 

Widowed. 

Totals. 

3,456,310 
30.2 

6,852,695 
57.6 

1,178,559 
10.2 

11,487,664 
100 

The  greater  liability  of  single  than  of  married  persons  to  insanity  is 
explained  in  part  by  the  fact  that  a  much  larger  proportion  of  the 
unbalanced,  odd,  idle,  worthless,  restless,  dissipated,  and  improvident 
do  not  marry.  The  causes  of  their  celibacy  and  insanity  are  radically 
the  same.  We  know  that  marriage  often  leads  to  insanity;  domestic 
troubles  and  afliictions,  and  all  cases  of  puerperal  insanity  being  the 
most  prominent.  Yet,  on  the  other  hand,  it  seems  to  prevent  a  much 
larger  number  of  cases  than  it  produces.  The  kindly  and  calming 
influences  of  the  domestic  circle,  the  greater  regularity  of  habits,  the 
freedom  from  inordinate  passions  and  dissipated  tendencies,  all  have 
their  due  efl'ects  in  keeping  the  mind  in  a  proper  state  of  equilibrium, 
which  is  sanity. 

It  further  appears  from  the  foregoing  table  that  while  the  greatest 
numbers  and  largest  proportions  of  the  insane  are  among  the  single  and 
the  smallest  among  the  married  population,  that  the  widowed  occupy  an 
intermediate  proportion,  thus  proving  conclusively  that  marriage  is  one 
of  the  most  powerful  agencies  in  preventing  the  increase  of  this  dread- 
ful malady. 


CHAPTER   V. 

INFLUENCE  OF  SOCIAL  DISTINCTIONS. 

Diseases  of  the  brain  are  peculiar  to  no  class  in  society.  They  are 
found  in  all  ranks  of  men — the  high  and  the  low,  the  refined  and  the 
vulgar,  the  educated  and  the  ignorant,  the  rich  and  the  poor — but  not  in 
the  same  proportion  in  all  classes.  The  brain  is  not  the  mind,  but  the 
organ  through  which  it  operates  and  through  which  it  manifests  itself. 
There  are  manifold  causes  and  various  conditions  by  which  it  is  dis- 
turbed. Many  and  various  events  and  external  circumstances;  many 
conditions'  of  the  body  and  nervous  system  affect  this  organ  morbidly. 
These  pervert  its  functions,  and  produce  mental  disorder.  These  disturb- 
ing causes  are  distributed  in  various  proportions  among  the  different 
classes  of  society;  none  are  entirely  free.     Some  causes  are  common  to 

*■  See  Bucknill  &  Tuke  on  Insanity,  p.  255. 


50 

all  ranks  of  men,  and  others  are  the  especial  dangers  that  hover  over 
each  of  the  several  classes.  The  distinctions  in  society  are  manifest 
and  inevitable,  but  not  more  certain  than  the  variety  of  dangers  that 
beset  their  mental  health. 

The  first  condition  of  man,  that  has  been  fixed  upon  him  from  the 
beginning,  is  the  necessity  of  protection  and  sustenance,  and  his  first 
motive  of  action  is  his  desire  to  obtain  them.  To  some  the  means  of 
living  come  easily.  Their  sagacity,  industry,  and  faithfulness  procure 
for  them  not  only  what  they  need,  but  enable  them  to  create  a  surplus 
sufficient  for  future  emergencies  and  for  more  expensive  and  luxurious 
living.  All  of  these  have  a  competence,  and  some  have  great  wealth, 
with  no  fear  of  want.  These  constitute  the  higher,  but  by  no  means  the 
largest  class  of  society.  Another  and  larger  class,  with  less  mental  and 
moral  power  or  opportunity,  obtain  what  they  need  from  day  to  day, 
and  have  thrift  enough  to  secure  the  means  of  meeting  the  ordinary 
wants  of  life  and  the  necessities  of  sickness  and  age  when  they  cease  to 
labor.  A  third  and  very  large  class  in  every  country,  called  the  labor- 
ing class,  not  because  they  work  more  than  the  others,  but  because,  hav- 
ing no  capij:al,  they  obtain  their  subsistence  by  the  labor  of  their  hands 
exclusively.  They  earn  from  day  to  day  what  thej  consume,  and  lie 
down  at  night  no  richer  than  they  were  in  the-  morning.  They  sustain 
themselves  as  long  as  strength  lasts,  but  when  sickness  overtakes  them 
or  old  age  falls  upon  them,  having  accumulated  no  capital  to  fall  back 
upon  they  become  dependent  upon  the  charity  of  friends  or  public 
bounty  for  support. 

Below  these  in  the  social  scale  arc  the  entirely  dejicndent  or  pauper 
class,  who  are  housed,  fed,  and  clothed  by  the  general  treasury.  These 
are  found  most  numerous  in  old  and  least  so  in  new  countries.  All  of 
these  classes  are  subject,  though  in  different  degrees,  to  insanity.  Beside 
the  courses  of  mental  disorder  that  arc  common  to  all,  some  appear  more 
frequently  and  act  with  more  destructive  power  on  some  classes,  while 
they  are  rarely  known  in  others.  As  a  general  law  the  most  favored 
class  have  the  best  natural  endowments  of  body  and  mind,  the  best 
physical  health,  the  best  mental  and  moral  training  and  discipline. 
These  give  them  their  position  and  enable  them  to  sustain  themselves 
'therein.  Their  wisdom  and  sagacity,  thtir  power  of  consideration  and 
of  adapting  means  to  the  desired  ends,  their  faithfulness  to  the  law  of 
their  being,  and  discreet  self  management,  insure  this  prosperity  and 
the  world's  confidence. 

Fortune  is  not  the  blind  goddess  as  commonly  represented,  scattering 
her  favors  without  regard  to  conditions  and  circumstances,  making  some 
rich  who  never  sought  for  her  blessings,  and  others  poor  in  spite  of  their 
well  laid  plans  and  earnest  endeavors.  As  a  rule,  accident  and  chance 
have  but  little  to  do  with  this  matter.  Success  is  almost  always  the 
result  of  fitting  plans  and  faithful  execution.  '-Herein  is  wisdom  justi- 
fied of  her  children,  and  folly  may  make  a  similar  boast,  the  child  is 
after  the  similitude  of  the  parent."  The  wisdom  may  be  merely  of  this 
world,  and  applied  to  a  narrow  field  wherein  riches  are  gathered,  or  one 
wherein  the  flowers  of  fashion  bloom.  It  may  be  a  better  wisdom  that 
leads  to  self  culture,  to  learning,  to  the  generous  and  peaceful  graces  of 
character.  Whatever  it  may  be,  it  is  sufficient  for  its  purpose.  Without 
this  wisdom  of  the  appropriate  kind  no  man  attains  to  his  desired  ends. 
A  man  may  be  a  fool  in  everything  else,  but  he  is  neither  foolish  nor 
weak  in  that  in  which  he  succeeds.     Success  in  any  line  of  life  is  then 


51 

evidence  of  wisdom  appropriate  to  that  purpose,  and  of  strength  suffi- 
cient for  its  accomplishment. 

The  simple  fact  that  men  are  in  the  higher  social  ranks  of  culture, 
character,  or  wealth,  must  be  accepted  as  prima  facie  evidence  that  they 
have  good  minds,  well  developed,  trained,  and  balanced;  that  they  have 
strength  and  discipline  of  character  by  which  they  reached  their  present 
2)osition  and  retained  themselves  in  it.  Being  generally  persons  of  good 
health  and  sound  mind  they  have  in  themselves  better  defences  against 
insanity  than  the  lower  classes  that  are  less  liberally  endowed  and  less 
favored  by  education  and  self  discipline,  l^evertheless,  the  more  favored 
and  prosperous  classes  have  their  peculiar  dangers  that  threaten  their 
soundness  of  mind.  Here,  temptations  to  excessive  mental  labor  in 
business,  study,  in  the  pursuit  of  riches  and  knowledge,  ambitious  pro- 
jects and  political  strife,  all  have  their  influence.  In  this  country,  where 
no  child  is  bound  to  follow  the  paths  of  his  father,  where  all  the  avenues 
to  wealth  and  distinction  are  open  to  any  who  desire  to  enter,  and  the 
race  of  life  is  free  to  every  competitor,  whatever  may  be  his  history  and 
preparation,  there  are  some  in  every  rank  Avho  are  struggling  with  all 
their  energy  to  grasp  what  is  almost  within  or  even  beyond  their  reach. 
Some  of  these  who  succeed  find  themselves  in  a  false  position,  which 
they  are  not  prepared  to  fill,  and  are  compelled  still  to  fight  the  battle  to 
sustain  themselves  in  form  and  appearance,  for  which  they  were  not 
educated.  In  this  class  are  the  dangers  of  great  reverses  in  business,  of 
graceful  and  fashionable  dissipation,  and  sometimes  of  gross  sensuality; 
of  disregard  to  the  natural  laws  of  health,  in  late  and  unusual  hours, 
unreasonable  eating,  inadequate  costume,  etc.  All  these  tend  to  over- 
work or  disturb  the  brain,  and  sometimes  the  mind  is  disordered  and 
insanity  follows. 

The  class  next  below  the  highest,  just  described,  is  composed  of  per- 
sons of  comparatively  limited  fortune.  They  have  less  strain  upon  their 
mental  powers.  Generally  they  have  a  more  even  course  of  life,  and 
are  more  contented  with  their  position;  their  moderate  gains  meet  all 
their  necessities  and  secure  them  against  suffering  in  days  of  sickness 
and  age;  yet  there  are  those  among  them  who  are  earnestly  striving  to 
rise  to  the  higher  place,  and  whose  ambition  lays  too  heavy  a  tax  on 
their  physical  and  mental  energies.  Some  break  down  under  this  un- 
natural strain  upon  their  powers.  In  this  class  there  is  less  waste  of 
health  and  force,  in  graceful  dissipation  than  in  the  class  above  them, 
and  in  coarse  and  vulgar  dissij^ation  than  in  the  classes  below.  These 
have  fewer  causes  of  insanity  peculiar  to  themselves  than  either  of  the 
other  classes;  and  though  they  furnish  the  smallest  number  of  victims 
to  this  disorder,  yet  they  have  their  dangers,  under  which  some  of  their 
members  lose  their  mental  health. 

The  poor  have  not  been  wanting  among  mankind  from  the  earliest 
records;  nor  until  the  human  constitution,  with  the  natural  passions  and 
appetites,  shall  be  changed,  and  men  and  women  conform  their  habits  to 
the  laws  of  health  and  restrain  their  self-indulgence,  will  the^oor  fail  to 
appear  in  every  successive  generation. 

In  the  world's  careless  estimation,  poverty  is  simply  an  absence  of  the 
outward  means  of  life,  food,  clothing,  shelter,  and  the  real  and  appar- 
ently sufficient  way  of  relief  is  to  supply  these  wants  or  give  their  value 
in  money.  This  is  but  a  suj^erficial  view  of  this  matter.  Poverty  is 
deeper  and  earlier  than  present  ascertained  destitution.  It  is  in  a  great 
measure  an  original  element  in  the  man;  in  his  constitution;  in  his  devel- 
opment and  education,  and  in  his  character. 


52 

This  class  is  filled  from  causes  opposite  to  those  that  fill  the  highest 
class.  The  jH-imaiy  grounds  of  prosperity,  sagacity,  coordinating 
power,  physical  strength,  industry,  perseverance,  self-discipline,  are  defi- 
cient in  the  poor.  As  a  class,  they  have  less  health  and  intellectual 
force;  less  perfect  development  and  education.  More  of  them  are  of 
unbalanced  mind,  of  unreliable  judgment;  they  are  more  changeable  in 
purpose;  their  j^lans  are  less  in  harmony  with  their  circumstances  and 
the  means  at  their  control,  or  their  power  of  execution.  Here  are  found 
more  of  the  victims  of  low  and  gross  dissipation — the  intemperate,  the 
debauched;  more  of  those  who  suffer  from,  hereditary  diseases. 

The  members  of  this  class  are  generally  laborers  for  wages,  and  a  large 
proportion  are  unskilled,  doing  the  work  that  simply  requires  muscular 
force  with  the  least  mental  exertion.  They  earn  a  bare  subsistence 
while  in  health,  with  little  or  no  surplus  to  depend  upon  in  sickness  and 
old  age.  They  exemplify  the  old  law,  that  "  from  him  that  hath  not 
shall  be  taken,  even  that  which  he  hath."  One  element  of  poverty 
begets  another,  and  this  creates  a  third,  and  still  others  follow,  until  the 
low  condition  of  the  man,  without  and  within,  is  complete.  As  his  earn- 
ings are  small  his  nutrition  is  meagre,  clothing  inadequate,  dwelling  nar- 
row and  unhealthy.  He  must  live  with  his  family  in  small  and  unven- 
tilated  rooms,  and  breathe  impure  air;  his  frame,  therefore,  is  not 
strengthened;  his  brain  is  inactive,  his  mind  cloudy;  he  must  conse- 
quently accept  the  coarsest  work  for  the  lowest  wages,  that  afford  no 
means  of  strengthening  his  body  or  elevating  his  mind  to  the  power  of 
more  profitable  labor.  Depressed,  languid,  torpid,  he  often  seeks  relief 
in  artificial  stimulants,  and  adds  another  fountain  from  which  poverty 
flows.  His  hard  and  exhausting  toils  destroy  his  buoyancy  of  spirit, 
take  away  his  hope,  and  neutralize  his  ambition  to  rise  to  a  better  scale 
of  life. 

From  the  original  and  constitutional  character  of  the  poor,  and  from 
their  habits  and  exposure,  there  is  much  insanity  among  them.  JPoverty 
and  insanity  often  spring  from  the  same  source.'  Persons  who  are  weak 
in  intellect,  undisciplined,  unbalanced,  fickle,  or  excitable,  are  wanting  in 
the  elements  of  success,  and  are  poor  for  this  reason.  Their  mental  and 
moral  condition  are  the  sources  of  much  insanity.  Their  imperfections 
or  perversities  grow  into  mental  disorder.  These  are  not  insane  because 
of  their  destitution,  nor  yet  poor  because  of  their  insanity;  but  they  are 
both  because  they  have  in  their  brains  the  elements  of  poverty  and 
mental  disorder.  So,  also,  intemperance  and  other  sensual  indulgences 
creates  the  double  destruction  of  estate  and  mental  health.  Drunken- 
ness is  one  of  the  most  fruitful  causes  both  of  insanity  and  pauperism. 

The  paupers,  the  lowest  in  the  social  scale,  have  still  more  the  ele- 
ments of  weakness.  There  are  among  them  more  than  among  others 
defective  and  disordered  constitutions;  more  diseases  both  of  body  and 
mind.  In  some,  their  disability,  original  or  acquired,  was  manifest; 
others  have  been  weighed  in  the  world's  balance  of  business  or  labor  of 
some  kind  and  found  wanting.  The  deficiencies  and  perversities  of  the 
previous  class  (the  poor  but  independent  laborers)  arc  intensified  in  this. 
At  least  the  paupers  live  nearer  the  borders  of  insanity  than  others,  and 
a  much  larger  portion  pass  that  bound  into  lunacy.  Beside  these  causes 
inherent  in  and  acting  on  the  dependant  class  to  produce  insanity,  they 
receive  a  large  supply  of  recruits  from  the  other  and  more  favored 
classes  on  account  of  mental  disorder.  Some  men,  sufiEiciently  secure  in 
their  self  sustaining  power,  by  their  skill  and  exertions  supply  all  their 
wants  until  they  lose  their  reason,  when  labor,  and  production,  and 


53 

income  cease  together.  If  the  mental  disorder  be  not  relieved,  and  life- 
long insanity  be  established,  the  accumulated  capital  will  soon  be 
exhausted,  and  the  j^atient  and  his  familj-  fall  upon  the  public  treasury 
for  support. 

In  some  cases  the  family  may  yet  have  power  to  support  themselves, 
especially  if  the  lunatic  be  not  the  head  and  principal  producer,  but  can- 
not add  to  this  the  board  and  care  of  the  patient.  Then  they  throw  him 
upon  the  town  or  State,  and  join  him  to  the  pauper  class,  while  the  rest 
of  the  family  remain  in  the  ranks  of  the  independent.  These  last 
described  are  not  made  insane  by  their  poverty,  but  their  insanity  made 
them  paupers.  In  this  way  insanity  hangs  about  the  necks  of  its  vic- 
tims in  all  the  social  ranks,  dei:)riving  them  of  the  power  of  j^roduction, 
and  consuming  an  undue  proportion  of  the  family  substance.  Under  this 
burden  they  gravitate  downward,  and  may  ultimatel}'  reach  the  lowest 
depths  of  pauperism.  Another  and  important  fact  is  discovered;  that  a 
very  large  portion  of  the  lunatics  in  the  pauper  class  are  chronic  cases, 
who  have  been  a  long  time  disordered,  and  whose  day  of  healing  is  past, 
and  whose  malady  will  end  only  in  death. 

From  all  these  and  manifold  other  causes  the  proportion  of  insanity 
among  the  paupers  is  vevy  great  as  com2)ared  with  that  of  the  higher 
ranks,  and  indeed  with  all  the  independent  classes  of  society. 

The  anniial  reports  of  the  Commissioners  in  Lunacy  for  England  show 
the  number  of  lunatics  in  the  independent  classes  and  among  the  paupers. 
From  these  and  other  British  reports  on  population  and  on  the  poor  the 
following  facts  as  to  numbers  are  derived,  and  the  proportion  of  lunatics 
in  the  classes  are  calculated  from  these  facts: 

During  the  ten  years,  eighteen  hundred  and  sixty-two  to  eighteen  hun- 
dred and  seventy-one,  the  average  annual  independent  population  was 
twenty  million  three  hundred  and  thirty-eight  thousand  seven  hundred 
and  ninety-two.  The  average  annual  number  of  indej^endent  lunatics 
was  five  thousand  nine  hundred  and  seventy-three.  The  ratio  of  luna- 
tics in  this  class  was  one  in  three  thousand  four  huiidred  and  five.  The 
average  annual  number  of  paupers  was  one  million  twent3'-one  thousand 
eight  hundred  and  seventy-two.  The  average  annual  number  of  pauper 
lunatics  was  forty-two  thousand  seven  hundred  and  sixty-four.  The 
ratio  of  lunatics  in  this  class  was  one  in  twenty-four.  The  proportionate 
ratios  of  lunatics  to  their  respective  classes  were  three  thousand  four 
hundred  and  five  to  twenty-four,  or  one  hundred  and  fortj^-two  times  as 
great  in  the  pauper  as  in  the  independent  classes  of  English  societ}'. 

The  pauper  lunatics  are  in  the  asylums  and  workhouses,  or  are  other- 
wise subject  to  ofiicial  supervision — their  numbers  therefore  are  known 
and  accurately  stated.  The  independent  lunatics  are  in  the  j)ublic  and 
I)rivate  asylums  and  hospitals,  and  under  the  guardianship  of  the  State, 
through  the  Lord  Chancellor  and  his  agents,  and  under  the  observations 
of  the  Commissioners  in  Lunacy:  but  there  may  be  others  not  known  to 
these  authorities  who  are  kept  at  their  homes  or  privately  boarded  else- 
Avhere.  These  are  not  included  in  this  statement  of  the  independent 
insane.  But  the  number  of  these  who  havci  escaped  the  vigilant  inqui- 
ries of  the  Governm.ent  officials  cannot  be  very  great;  admitting,  how- 
ever, that  there  were  as  many  as  were  revealed  and  reported  or  even 
three  or  four  times  as  many,  still  the  differences  of  the  burden  of  lunacy 
resting  on  the  pauper  class  is  enormous  in  comparison  with  that  which 
the  more  favored  classes  are  doomed  to  sufi'er. 

There  was  a  similar  disproportion  of  insanity  in  the  pauper  and  inde- 
pendent classes  of  Massachusetts,  as  shown  by  the  report  of  the  Com- 


54 

missioners  in  eighteen  hundred  and  fifty-four,  and  it  is  probable  that  the 
same  exists  in  every  civilized  country. 

Unfortunately,  ^ye  have  no  means  of  showing  this  in  the  United 
States  and  most  other  countries,  though  the  accomj^anying  table  shows 
that  they  constitute  a  majority  of  the  insane  in  Scotland,  Ireland,  and 
Belgium,  as  well  as  in  England,  notwithstanding  the  proportion  of  the 
pauper  j^opulation  would  not  exceed  a  twentieth  of  the  whole  in  any  of 
these  countries: 


Population. 

^ 

» 

^ 

p 

Proportion  of— 

co^^^TRY. 

t 

—1 

5' 

? 

P 

? 

P 

— ! 
-1, 

5' 

Pauper  Insane  and  Idiots  to 
Total  Insane  and  Idiots 

c 
p 

r 

Eniiiland 

22.090,163 
3,222,837 
5,195,236 
4.984,451 

54,713       48,433    88  per  cent 

9,571;       6,276    65  per  cent 

17.194!       9  498    55  ner  cent 

1  in    456 

Scotland 

lin    513 

Ireland 

1  I'n    ^4.a 

Belcium 

7  4.^.1           R  8!S9     P^9  npr  ppnt     1  in  1  9P4 

Total 

35,492,687  !    88,909 

68,059 

76  per  cent     1  in  521 

It  has  been  explained  elsewhere  and  must  not  be  overlooked,  however, 
that  a  large  majority  of  these  pauper  lunatics  are  no  more  furnished  by 
the  pauper  element  in  society  in  these  countries  than  are  the  non-paying 
patients  in  our  own  institutions;  most  of  them  were  self-sustaining  and 
independent  citizens  till  misfortune  assailed  them  and  deprived  them  of 
their  reason  and  the  power  to  labor.  Yet  all  must  admit  that  pauperism 
is  one  of  the  most  prolific  sources  from  which  insanity  is  supplied.  Here 
is  a  grave  question  for  the  consideration  of  those  in  authority',  whether 
the}^  niay  not,  by  providing  means  sufiicient  to  accommodate  and  care 
for  every  one  who  becomes  insane,  thereby  aftbrding  proper  treatment 
in  the  early  stages  of  the  disease,  restore  most  of  these  unfortunate 
victims  of  this  direful  malady  to  health,  the  power  to  serve  themselves, 
their  families,  and  the  State,  and  whether  this  is  not  a  duty  which  every 
commonwealth  owes  to  itself  and  to  its  members? 


CHAPTEE    YI. 

APPARENT  INCREASE  OF  INSANITY. 


For  many  years  it  has  been  apprehended  that  this  fearful  malady  was 
increasing,  not  only  in  our  own   country,   but   in   all   other  civilized 


55 

nations;  and  as  early  as  eighteen  hundred  and  fifty-one  Doctor  Jaryis 
read  a  paper  on  the  subject  before  the  Association  of  Medical  Superin- 
tendents of  American  Institutions  for  the  Insane,  in  which  he  said:  "It 
is  a  recent  thing  that  any  nation  has  enumerated  its  insane,  and  I  cannot 
discover  that  any  nation  has  ascertained  and  reported  this  twice,  and 
thus  offered  us  data  for  the  comparison." 

Since  that  time  other  nations  have  taken  an  account  of  their  insane, 
and  some  of  them  several  times,  but  only  to  prove  that  insanity  has 
increased,  at  least  apparentl}',  and  in  some  countries  very  rapidly,  within 
comparativel}'  a  short  time.  Thus  the  following  table,  from  official 
reports,  will  show  the  result  in  the  countries  named: 

UNITED    STATES — TWENTY    YEARS. 


Year. 

Population. 

Number 

of  Insane  and 

Idiots. 

Eatio  per  1,000 

to 

Population. 

Proportion 
to  Population. 

1850 
1860 
1870 

23,191,876 
31,443,322 

38,555,983 

31,397 

42,864 
61,909 

1.35 
1.36 
1.60 

1  in  738 
1  in  733 
1  in  623 

ENGLAND — TEN    YEARS. 


1862 

1865 
1868 
1871 


20,336,467 
20,990,946 
21,649,377 

22,704,108 


41,129 
45,950 
51,000 
56,755 


1  in  494 
1  in  456 
1  in  424 
1  in  400 


SCOTLAND — TEN  YEARS. 


1862 
1865 
1868 
1871 


3,083,989 
3,136,057 
3,188,125 
3,358,613 


1  in  486 

1  in  484 

1  in  459 

1  in  430 


IRELAND — NINETEEN   YEARS. 


1851 

1856 
1861 
1870 


6,552,385 
6,164,171 
5,798,967 
5,195,236 


15,098 
14,141 
16,749 
17,194 


1  in  434 
1  in  435 
1  in  346 
1  in  303 


56 


FRANCE — FIFTEEN   YEARS. 


1851 
1866 


35,783,170 

37,988,905 


1  in  795 
1  in  418 


This  shows  that  the  ratio  of  insane  and  idiots  per  one  thousand  in  the 
United  States  in  eighteen  hundred  and  fifty  was  one  and  thirty-five  one 
hundredths,  or  one  in  seven  hundred  and  eight,  and  in  eighteen  hundred 
and  seventy,  one  and  sixty  one  hundredths,  or  one  in  six  hundred  and 
twenty-three. 

In  England,  in  eighteen  hundred  and  sixty -two,  it  was  two  and  two 
one  hundredths,  or  one  in  four  hundred  and  ninety-four,  and  in  eighteen 
hundred  and  seventy-one,  two  and  forty-nine  one  hundredths,  or  one  in 
four  hundred.  In  Scotland,  in  eighteen  hundred  and  sixty-two,  it  was 
two  and  five  one  hundredths,  or  one  in  four  hundred  and  eighty-six,  and 
in  eighteen  hundred  and  seventy-one,  two  and  thirty-two  one  hundredths, 
or  one  in  four  hundred  and  thirty.  In  Ireland,  in  eighteen  hundred  and 
fifty-one,  it  was  two  and  thirty  one  hundredths,  or  one  in  four  hundred 
and  thirty-four,  and  in  eighteen  hundred  and  seventy-one,  three  and 
thirty-nine  one  hundredths,  or  one  in  three  hundred  and  two.  In  France, 
in  eighteen  hundred  and  fifty-one,  it  was  one  and  twenty -five  one  hun- 
dredths, or  one  in  seven  hundred  and  ninety-five,  and  in  eighteen  hun- 
dred and  sixty-six,  two  and  thirty-eight  one  hundredths,  or  one  in  four 
hundred  and  eighteen. 

But  even  these  statements  must  not  be  taken  as  altogether  correct. 
In  the  paper  of  Doctor  Jarvis,  already  referred  to,  he  shows  how  very 
carelessly  the  returns  from  France  had  been  made,  and  so  it  may  have 
been  with  those  from  which  our  figures  were  taken:  Statistique  de  la 
France,  1866,  second  series.  Vol.  XYII.  In  the  United  States  we  have 
also  shown  that  all  of  the  insane  and  idiots  have  probably  not  been 
found.  In  England,  Scotland,  and  Ireland,  the  reports  are  mainly 
ofiicial,  showing  the  number  in  institutions  for  custody  and  cure,  in  pau- 
per establishments  Avhere  they  are  kept  merely  for  support,  and  those 
under  the  guardianship)  of  the  Lord  Chancellor's  Commissioners. 

It  is  probable  there  are  many  others  who  belong  to  neither  of  these 
categories.  Nor  must  these  facts  induce  the  conclusion  that  insanity,  if 
it  has  increased  at  all,  has  done  so  in  anything  like  the  proportion  here 
indicated.  The  existence  of  a  fact  and  our  knowledge  of  it  are  two 
very  different  things.  Electricity  has  existed  for  all  time,  but  our 
knowledge  of  its  properties  and  the  purposes  to  which  it  may  be  use- 
fully applied  is  of  veiy  recent  date.  So  it  may  be  in  many  respects 
with  our  knowledge  of  the  insane.  We  have  already  shown  that  many 
had  existence  in  Massachusetts  who  could  not  or  had  not  been  found  by 
one  set  of  Commissioners  who  were  found  by  another  Commission  whose 
method  of  search  was  different  and  whose  work  was  more  thorough. 
Nor  must  it  be  overlooked  that  since  greater  attention  has  been  paid  to 
the  insane  than  formerly  many  more  are  brought  to  light  and  seek  the 
benefit  of  asylum  accommodation.  Add  to  this  the  important  fact  that 
the  duration  of  life  among  the  chronic  insane  has  been  much  increased 
by  the  greater  amount  of  care  and  the  more  humane  treatment  which 
they  receive,  and  we  can  readily  account  for  at  least  a  portion  of  the 
apparent  increase. 


57 

It  is  exceedingly  interesting  to  trace  this  apparent  increase  of  insanity 
in  the  various  countries  of  the  world,  and  easy  to  show  how  much  more 
rapidly  the  increase  has  been  brought  to  light  in  those  countries  where 
the  most  humane  and  liberal  provisions  have  been  made  for  their  accom- 
modation. We  will  show,  however,  that  it  is  not  confined  to  the  present 
epoch,  nor  to  any  particular  country;  but  that  it  has  always  and  every- 
where come  forth  from  its  recesses  and  hiding  places  whenever  suitable 
hospitals  for  the  reception  of  its  victims  were  provided.  Thus  Bucknill 
ct  Tuke  state  that  "in  the  short  space  of  iiineteen  years  the  estimated 
l^roportion  of  the  insane  in  England  rose  from  one  in  seven  thousand 
two  hundred  to  one  in  seven  hundred  and  sixty-nine;"  while  on  the 
first  of  January,  eighteen  hundred  and  seventy-one,  there  was  one  to 
four  hundred.     This  is  simply  insanity  revealed  by  increased  attention. 

The  following  extracts  from  the  paj^er  of  Dr.  Jarvis  on  this  subject 
will  show  the  results  in  several  States  and  countries  at  a  former  period: 

"  Thus  we  find  that  whenever  the  seeds  of  this  interest  are  once  sown 
and  allowed  to  germinate  and  grow,  it  spreads  continually  thereafter. 
AYhenever  the  attention  of  the  people  of  any  country  is  called  to  this 
subject,  and  a  hospital  is  built,  there  follows  a  remarkable  increase  of 
the  cases  of  insanity  revealed  to  the  public  eye  and  asking  for  admis- 
sion. 

"  In  the  year  eighteen  hundred  and  thirty-two,  when  the  McLean 
Asylum  at  Somerville,  Massachusetts,  contained  sixty-four  patients,  the 
State  Lunatic  Hospital  was  established  at  Worcester  for  one  hundred 
and  twenty  patients.  This  was  as  large  a  number  as  was  then  suj^posed 
would  need  its  accommodation.  In  eighteen  hundred  and  thirty-six  one 
new  wing,  and  in  eighteen  hundred  and  thirty-seven  another  new  wing, 
and  rooms  for  one  hundred  more  patients  were  added  to  the  Worcester 
Hospital,  and  at  the  same  time  the  McLean  Asylum  contained  ninety- 
three  lunatic  inmates.  In  eighteen  hundred  and  forty -two  the  Worces- 
ter Hospital  was  again  enlarged  by  the  addition  of  two  new  wings,  and 
now  these  are  all  filled  to  overflowing,  having  four  hundred  and  fifty 
patients  in  May,  eighteen  hundred  and  fifty-one,  while  at  the  same  time 
there  were  two  hundred  at  the  McLean  Asylum,  two  hundred  and  four 
at  the  City  Lunatic  Hospital  at  Boston,  and  one  hundred  and  fifteen  in 
the  county  receptacles  for  the  insane  at  Cambridge  and  Ipswich,  beside 
thirty-six  in  the  jails;  making  one  thousand  and  fifteen  lunatics  in  the 
public  establishments  of  Massachusetts  in  eighteen  hundred  and  fifty- 
one,  instead  of  the  one  hundred  and  eighty-two  which  were  there  in 
eighteen  hundred  and  thirty-two  " — an  increase  of  eight  hundred  and 
thirty-three  in  nineteen  years. 

"Besides  these  there  is  now  a  great  demand  for  the  admission  of 
patients  who  cannot  be  accommodated  in  these  establishments  already 
built,  and  there  is  so  much  interest  elicited  in  their  behalf,  and  the 
friends  of  the  lunatics  are  so  alive  to  the  necessity  of  providing  means 
of  relief  for  all  of  these  sufferers,  that  the  Legislature  has  just  now 
authorized  the  erection  of  a  new  hospital  sufficiently  large  to  receive 
two  hundred  and  fifty  patients. 

"  The  State  Hospital  at  Augusta,  Maine,  was  opened  in  December, 
eighteen  hundred  and  forty,  with  only  thirty  patients.  In  eighteen 
hundred  and  forty-five  it  was  so  crowded  that  the  Trustees  asked  for 
more  rooms.  In  eighteen  hundred  and  forty-seven  the  building  was 
enlarged,  and  one  hundred  and   twenty-eight   patients  were  admitted. 

8 


58 

In  eighteen  liundred  and  forty-eight  the  house  was  all  filled,  and  more 
were  offered  than  could  be  accommodated,  and  the  Superintendent  asked 
the  Legislature  to  build  still  another  wing,  to  enable  him  to  meet  the 
increased  demand. 

"  The  'New  Hampshire  Hospital  was  opened  in  eighteen  hundred  and 
forty-two,  and  received  twenty-two  patients:  these  were  all  that  were 
offered.  In  eighteen  hundred  and  forty-three  these  were  increased  to 
forty-one;  in  another  year,  eighteen  hundred  and  forty-four,  there  were 
seventy;  in  eighteen  hundred  and  forty-five  there  were  seventy-six;  in 
eighteen  hundred  and  forty-six  there  were  ninety-eight;  and  in  eighteen 
hundred  and  fifty  they  reached  the  number  of  one  hundred  and  twenty. 
In  the  meantime  additions  have  been  made  to  meet  this  growing  demand 
for  more  and  more  accommodations. 

"  The  number  of  patients  in  the  Eastern  Virginia  Asylum  at  Williams- 
burgh  has  increased  more  than  two  hundred  j^er  cent  in  fifteen  years — 
from  sixty  in  eighteen  hundred  and  thirty-six,  to  one  hundred  and 
ninety-three  in  eighteen  hundred  and  fifty. 

'^  Those  in  the  Western  Virginia  Asylum  at  Staunton,  have  increased 
more  than  eight  hundred  per  cent  in  twenty-three  years — from  thirty- 
eight  in  eighteen  hundred  and  twenty-eight,  to  three  hundred  and  forty- 
eight  in  eighteen  hundred  and  fifty. 

'•'  The  average  number  of  patients  in  the  Ohio  State  Lunatic  Asylum  at 
Columbus,  was  sixty-four  in  eighteen  hundred  and  thirty-nine,  and  three 
hundred  and  twenty-eight  in  eight.een  hundred  and  fift}^ — being  an 
increase  of  more  than  four  hundred  per  cent  in  eleven  years. 

'•  Now,  no  one  would  imagine  that  the  population  of  these  several  States 
has  increased  in  these  ratios  of  the  increase  of^the  lunatics  in  their  asy- 
lums within  these  respective  periods.  But  it  will  readily  be  supposed 
that  the  opening  of  these  establishments  for  the  cure  or  the  protection 
of  lunatics,  the  spread  of  their  reports,  the  extension  of  the  knoAvledge 
of  their  character,  power,  and  usefulness  by  the  means  of  the  j^atients 
that  they  protect  and  cure,  have  created  and  continue  to  create  more 
and  more  interest  in  the  subject  of  insanity  and  more  confidence  in  its 
curability.  Consequently,  more  and  more  persons  and  families  who,  or 
such  as  who  formerlj^  kept  their  insane  friends  and  relations  at  home,  or 
allowed  them  to  stroll  abroad  about  the  streets  or  country,  now  believe 
that  they  can  be  restored  or  improved,  or  at  least  made  more  comforta- 
ble in  these  public  institutions,  and  therefore  they  send  their  patients  to 
these  asylums  and  thus  swell  the  lists  of  their  inmates. 

'•  For  the  same  reason  the  people  in  the  vicinity  of  lunatic  hospitals 
send  more  patients  to  them  than  those  at  a  greater  distance.  Thus  the 
County  of  Worcester,  Massachusetts,  has  sent  one  lunatic  out  of  every 
one  hundred  and  sixteen  of  its  population,  while  the  most  remote  coun- 
ties of  the  State  have  sent  onl}'  one  in  three  hundred  and  sixty-one  of 
their  people  to  the  State  Hospital  since  its  first  establishment. 

'•  In  New  York,  the  County  of  Oneida  has  sent  one  in  three  hundred 
and  sixty-one,  and  the  remotest  counties  sent  only  one  in  fifteen  hun- 
dred and  twenty-three  of  their  people  to  the  State  Lunatic  Asylum  at 
Utica. 

"  In  Kentucky,  the  people  of  Fayette  County  sent  one  in  eighty-nine  of 
their  people  to  the  Lunatic  Hospital  at  Lexington,  while  the  farthest 
counties  sent  only  one  in  sixteen  hundred  and  thirty-five  of  their  popu- 
lation to  that  institution. 

'•Similar  differences  in  the  use  of  the  public    hospital  are  found  in 


59 

Maine,  New  Hamj^shire,  Connecticut,  Ohio,  Maryland,  Tennessee;  and 
doubtless  in  other  States  the  same  will  be  found  on  investigation. 

"  To  infer  the  number  of  lunatics  in  the  community  from  the  number  in 
the  hospitals  is  about  as  unsafe  as  to  infer  the  number  of  births  from 
the  number  of  children  in  the  schools.  The  first  element  here  is  want- 
ing: that  is,  the  proportion  of  all  the  children  that  are  sent  to  school. 
Now,  as  this  is  very  different  in  Massachusetts  and  England,  and  Spain 
and  Egypt,  no  reasonable  man  would  venture  to  compare  the  number  of 
births  in  these  several  countries  by  the  population  of  their  school 
houses.  The  provision  for  the  cure  and  custody  of  the  insane  in  these 
countries  differs  as  widely  as  their  provisipn  for  the  education  of  child- 
ren; and  yet  writers  have  given  us  the  comparative  numbers  on  this 
ground,  as  in  London  one  in  two  hundred,  because  there  were  seven 
thousand  in  the  metropolitan  hospitals,  and  in  Cairo  one  in  thirty  thou- 
sajid  seven  hundred  and  fourteen,  because  there  were  fourteen  in  the 
hospitals  of  that  city. 

"It  must  be  further  considered  that  many  of  these  statements  that 
were  put  forth  as  positive  facts  are  given  in  such  round  numbers  as  to 
alford  good  reason  for  supposing  that  they  or  their  elements  are  esti- 
mates rather  than  actual  enumerations. 

"  Thus,  in  some  works  on  this  subject,  there  are  stated  to  be  thirty -two 
thousand  lunatics  in  France;  sixteen  thousand  in  the  United  States; 
seven  thousand  in  London;  four  thousand  in  Paris;  two  thousand  in 
Pennsylvania,  and  one  thousand  in  Massachusetts.  Millingen  says  the 
j^roportion  of  lunatics  to  the  people  is  one  in  one  thousand  in  England, 
and  in  France  one  in  one  thousand. 

"One  department  in  France,  Ariege,  gives  three  hundred  vagabond 
lunatics  for  four  successive  years,  without  change,  but  these  suddenly, 
in  the  fifth  year,  diminish  to  two  hundred  and  fifty,  and  in  the  seventh 
year  disappear  entirely.  Another  department,  Seine  Inferieure,  reports 
two  hundred  lunatics  for  seven  successive  years,  and  another  three  hun- 
dred for  three  successive  years  in  private  families.  Saone  Haute  reports 
none,  either  in  private  families  or  as  vagabonds,  for  two  years,  when 
suddenly  in  one  year  there  appears  to  be  one  hundred  and  ninety -three. 
Sarthe  reports  two  hundred  and  seventy-three  lunatics  in  families  in 
eighteen  hundred  and  thirty- seven,  and  then  they  all  disappear  and  are 
reported  no  more.  Mayence  reports  eight  in  families  and  as  vagabonds 
in 'eighteen  l\undred  and  thirty-five.  These  are  increased  to  two  hun- 
dred and  nine  in  eighteen  hundred  and  thirty-seven,  and  diminished  to 
twenty-one  in  eighteen  hundred  and  thirty-eight,  and  to  eight,  the 
original  reported  number,  in  eighteen  hundred  and  forty-one.  There 
are  so  many  of  these  a2')parent  inaccuracies,  such  full  and  round  num- 
bers, and  such  unvarying  totals  Avhere  there  must  be  some  change,  and 
such  sudden  and  violent  changes,  out  of  all  relation  to  the  ordinarj^  cir- 
cumstances of  society,  that  we  are  compelled  to  look  with  distrust  \i])on 
the  whole,  and  consider  it  as  but  little  better  than  mere  guess  work, 
with  more  or  less  foundation  in  fact." 

As  more  attention  has  been  paid  to  the  insane  within  the  last  twenty- 
five  years  than  ever  before,  we  may  fairly  conclude  that  their  numbers 
have  been  more  accurately  ascertained  and  reported,  at  least  in  some 
countries.  The  foregoing  extracts  prove  how  rapidly  this  malady 
appeared  to  increase  prior  to  eighteen  hundred  and  fifty-two  in  all  the 
States  and  countries  where  liberal  provision  had  been  made  for  its 
proper  treatment.      We  have  shown  its  increase  in  England  and  the 


60 

United  States  since  that  time,  and  the  Chapter  on  insanity  in  France 
affords  a  comprehensive  view  of  the  disorder  in  that  country.  But  let 
us  see  what  has  been  the  result  in  the  several  States  and  Territories  of 
the  United  States,  respectively,  within  the  last  twenty  years.  The  fol- 
lowing table  shows  the  population,  the  number  of  the  insane,  the  num- 
ber of  idiots,  and  the  ratio  of  each  to  the  total  population,  in  eighteen 
hundred  and  fifty,  eighteen  hundred  and  sixty,  and  eighteen  hundred 
and  seventy.  It  will  be  observed  that  the  ratio  of  the  insane  has 
increased  from  one  in  fourteen  hundred  and  eighty-five  to  one  in  thir- 
teen hundred  and  ten  during  the  first  period  of  ten  years,  and  to  one 
in  ten  hundred  and  thirty-one  in  eighteen  hundred  and  seventy;  while 
during  the  whole  period  of  twenty  years  the  idiots  are  not  so  numerous 
in  proportion  as  they  were  in  eighteen  hundred  and  fifty,  being  at  that 
time  in  ratio  of  one  in  fourteen  hundred  and  seventy-six,  and  in  eighteen 
hundred  and  seventy,  one  to  fifteen  hundred  and  seventy-one.  "We  haj'e 
neither  time  nor  space  to  analyze  each  State  separately,  but  the  curious 
can  do  so  for  themselves,  as  the  facts  appear  in  the  tables. 


TABLES 


62 


Si 


"S" 


o 

^ 

o 

00 

tH 

^ 

,. 

^ 

-Ki 

w 

■XJ 

« 

>-; 

•o 

,^ 

M 

o 

< 

^ 

■^ 

H 

-.^ 

'^ 

-S^ 

^^ 

fis 

lO 

CD 

■■^j 

f^" 

o 

'^ 

■S 

Ratio  of  Idiotic  to 
Population 

Ratio  of  In  sail  G  to 
Population 

Idiotic  

Insane 

Population 


Ratio  of  Idiotic  to 
Population 


Ratio  of  Insane  to 
PopulatioJi 

Idiotic 

Insane  

Population 


cc  i.c  -+i  I--  :c  -H  lo  o  i-i  cc  u:;  o  *>!  'N  Tti  jvi 
CO  c-i  i^  Tt<  CO  1--  'O  cc  ^  cc  CO  o  d  I-.  S  o 

<i2^l^Tt<_O^O^O^O_-r)^_C5_'^C0  CO  O  00  05  (>J 

oooooooooooooooo 

O  O-l  lO  CO  t^  O  GO  CO  CO  -Tt<  1>  -— I  «t  CO  c-i  t-^ 
--I  1--  O  CO  CO  1^  .-I  iC  O  O  lC  1-1  lO  O  Ci  C-l 
CO^O^O_X  '0_QO_:C^--H^O_CO_CO^t-~  X  rH  CO  <M 
i-Tco'uO         i-Tr-TuOOCrCsrr-rco'o'rH'Tir        r-T 

OOOOOOOOOOOOOOOO 

ict^!r)cq:ci^oo'*coi--CM~-ooi--coio 

CC  CO  W  -*  O-l  :C  CO  Oq  00  C:  CO  T-l  lO  Ttl  lO  o 
00^ lO  1-1   (M     1-  O  C5  c-j   o^^  ^  CO 


0  1-t^!r!.-(OuO.-(COLO<-IOCOC^'*<0 

o  o  CO  ic  CO'  c:o  CM  c:i  CO  CO  o  r-i  CM  -^o  o  CO 

O  'M    ^  C-l       -<^  CO  O  Ol    CO  1-H  t^  lO 


»H  CO  b-  UC  rH  X  C5  t^  CO  Ci  GO  O  CO  CO  CO  tH 
O  Ci  Ol  rH  UO  T-^  CO  CO  i-O  1^  -r^  r-<  — I  CO  1^  CO 

*^,'^"l'^^,'~l.'I~'l"l^"  't-^  ""t.^^  't-""'  ~l, 
cT  -jh"  uo"  cT  cT  0  r  —  I  -  ^^  d~  -r  1-  u-f  ~7  x"  i-^ 

CM  CO  CO  X  CO  r-^  -^  1-  ^  i-o  1-  c:  LO  cr  -M  X 

-*  Ci  •*  CO  Tji  r^  >-i  O  1-  CO  CO  rH  i-i  t-  CO'  CO 


co-HLrox'-(-*c:c-:tiicco'i^ 

1^  Oa  CM  CM  Oi  Ci  CM  CO  -t^  i-O  rt< 

-*COXCMCM05-*ICOCOOO 


ooooocoooo 


i-t  ^  -M  Cj  Ci  CO  CI  1^  X  LO  I^ 
X  i-H  CO  O;  X  -+1  -ti  Oi  W  iCI^ 
-:t^CO  CO  CM^l^  CO^C^1-^lO_1^  lO 

rH  CO  CO  CO    T-ri-rc>fco''r-r'^ 

ccoopoooooo 


CO  CO  LO  i>  i^  oq  CO  -*  CO  X  Tti 

O  l-~  ^         X  O  CO  CO'  CO  CO  C3 
1-  -*  r^         0\  CO  CO  CS 


o  CO  CO  cq  O  X 

T-(  CO  CO         l-^  CO 

CO  C-l  ^ 


^  rt^  X  CO  01 
<  CM  CO  CO  •# 


CO  CO  W  1^  O-l  Ol  LO'  LO  O  CO  -^ 

I^  01  Ci  Ci  Oi  CO  rf<  X  1^  I— I  --H 

X^  CO^ X^  lO_ l-^  lO  '^JH^  rH^ -^__ 'Tl^^ O'l^ 

r-n"  .-T  crT  of  cT  r-T  t^  :o' r-T  Qc"  0-f 
cr.'  1--  o  'O:;  w  05  X  o  LO'  X  crs 

r-^_l-^  CM         CO  CiiXD^Zi^ 

'ox 


S   c3 


c;  p.o 


o  t^-^  S3-3 


CO   lOO   rH 
Xl-r-l   05 

C0^C»^O^'iH_ 
r-Tofr-TrH" 

o  o  o  o 


CO  X  ^'O 
X_^L0^O_O^ 

SSSB 


!:>.  -^ti  1-^  <-( 
O  1^  l^  Oi 

Oi  tH  lO  CO 


Ol  O  CO  Tt" 
uO  C<1  lO  lO 


LO  oi  Ci  TJ^ 

O  CO  CO  CO 

ofi^co'co" 

X  --(  X  x 
Ci  O  lO  UO 


>.ci 
t/-'  i^  ci 


i;:^  T^-^  ^  c=-C  ^-^.S  ?e  '^^-i-a  O 


63 


O  c:  :r)  -I  o  -^ 
C<l  Tti  (M  -+1  O  '-' 

o  o  o  o  o  o 


o  i-i  ci  c-i  iX  t^  1^  -x  o  ci  o  X  i^  :  CO 

1--  ^+11^  i-H  O  C5  1^  CO  -*<  I-':  Ci  Ci  -+1  •  rH 

Ci  »  'O  o  io  "^i  ic  i-  i^  c<j_C5_.-(  o|_  :  o_ 

^r-rr-r.-rrO~.-rrH  rH^r-Tof  rH  r-T  ]   OO 

ooooooooooooo  *.  o 


C5  O 
CC  CO 
CC  1- 


X  3i 

CO  >o 
cc^o_ 

o  o 


c^i  :c  M  1-1  o 

o  o  o  o  o  o 


-fi  -t<  O  O  !M  X  lO  O  C^l  CO  O  iC  lO 

o  1-H  cs  iro  o  c^t  o  :c  (M  i^  X  TtH  CO 


oooooooo 


o  o  o 

4-^  -^  -«-^ 


CO  (M  CO 

o  c  o 


C-1  CO  ^  OS  O  CO 

»H  CO  CO  :c  — I 

l^CO        (N  iC 


O  lO  ^  O  X  O  (M 

CO  :o  --I  X  X  -^  -" 
CO  CO  co^o  i-^ 


^,  .  .  CO  -— I  .— I  CO  Oi 
-^  O  O  X  O  CC'  1^ 
X  1-1  TjH  X  (M  C<l  fM 


UO  r-l  l.-O  Cq  O  lO 
O  iO  C<1  1-  1- 
-I  Cq         CM  l^ 


!r;C5i--ococo<r^xi-^oiocoai 
oX'-iccjCic^'-cx.-iTfH'Mait^ 
lO  iC  CO  o  c^i       "     "■ 


CO'  1-1  TfH  fM  o5  , 

>i  CO  :c  T— I  :c 


UO  ■>!  C<1  lO  I^  Ol  1^  0<l  T-H  iM  t^  Ci  -*  O  -— I  Oq  t^  C5  CC  CO 

CC"— ic^icii— irt<if:i^cO'*:ca5cci^o^i^'*icoT-ico 
o  '--j^o^co_co_aq_ao_o^o^LO_o^io -*^co^o  co^oo^o  --^o^ 
,-H~crc-fT4'co'x'o"ccc-fi--^c-forc^fco~Ttrco~cr.-H~io~'--c" 

CO  -*l  "-C  C5  l^  CN  (M  1^  X  Ci  CO  lO  O  1-^  O  O  O  rH  CI 
CI  1.^  rH  1^  rH        CO  O  X  Oi  CO    Ci  r-ll-^  rH  O  CO  LO 


l^Ci  CC 
Ci  CO  1- 

rH  X  O 


rH  LC  X 
-f  Ci  1^ 
iC  CM  O 


t~-  CO  1^  <M  O 

o5  ;h  o  i-^^c^^ 

i-TofcC^C^TrH 


^  .  .      .     _   O  UO)  -*  O  01 

OOiOiMl^OJO^JXTt^iOO 
^X^O^Tt^CO^lO^OI  Ci  rH  o  o  oi_ 
^  rn"  rH  rH  Co"  rn"  rH  rn"  rH  of  rn"  r-T 


o  o  o  o  o  o 


ooooooooo 


01  O  1:^>-I  CO 
Ci  C5  !■-  O  O 
lO  C5  O  !■-  O 


coooo 


rHOlOS^rflCiXOLOTt^OrHCC 
'fCIIJO-lOOiOOXXCOTt^CCCC 
X  Ol  C^l  l^  lO  CC  (M  CD  CC  -+I  l^  uO  Ttl 


ooooooooooooo 


in  CC 

OS  l^ 

UO  of 

o  o 


rH<55  rH  Ol  t^ 
ox         0-1  lO 

l^  rH  Ol  CO 


rH  C5  lO  rt<  rH  -^  1^  rt<  X  CC  TfH  O  Ol 
OrHCCCi-JD  CCrH'TtH-tOCJX 

CO  Tfi  CC'  1^  CO      -^  ^  CC  y:>  :-t  o}  ^ 


O  CO  rH  Ci  Ol 
X  CO  Ol  CC 
CC  rH  rHOl 


xorHor^iCTt^t^cit^i^oo 

l^  1^  Ol  rH  rH    rH  rH  r^  O  CO  CC  1^ 

CO  CO  O  iC  CO-   CI  Ol  OJ  Tfl    lO  Oi 


-^  nj  Tp  ^j  i^j  "-^  ^^_j  u^  l^»  1^^  Ol  O'  ^^ 

l^  lO  Ci  CO  C-1  Ci  X  -*  O  rH  Ci  Ol  CC 

3i   lO   CO  O  CO  Ol  1^   LO   LO  l^   iC   rH  CC 


-f  I-  ;c  -c;  Ol 

Cj  C5         O  X 

O  CO         CC  CC 


CC  lO  ^  Ci  O  r^i  CC  L' 

1^  UO  Ci  CO  C-1  ~-  '^  ^ 

Ci  io_co^o_co^_^_  ^  -    V-    —     ■  — 

Ci  l-^CrrcTcO^rH  l^OcTof  of -J^^rH 
r-,XCiCCXrHrH^CCOrHrH01 
CO  ^  0_X  Ci_       CO_rH  CC  O  Ol  CO  tH 

"  "        of  rH  rf 


CO 


li^  o 


^4.  a 

'/i   i-  ci 

^  ci  b".  Oq 


c;  o  o 


ci  O 

X    r;    O 

~   '■-/•-    o  ^   o 


o-H*^  g  ^%S'. 


g^^^§^^t^^;^^5o£Si^H>f^^^S|fil^^! 


64 


^ 


•2 
I' 


Katio  of  Insane 
and  Idiotic  to 
Poi^ulation 


Total  Insane  and 
Idiotic 


Eatio  of  Idiotic 
to  Population. 


Ratio  of  Insane 
to  Population. 


Idiotic 


Insane 


Population 


oooooooooo 


S  S  S  S  S  '^  "^ 


1^  O  GO  1^  «  1^  ^  t-^  LC  -tl  M  CO  'J'  O  Tfi  C5  O  l^  CO 
'O  u'^C0_O_T^^u't_0C_Gl0  CO_0_C-l_(N_CC_rH_uO_C::5  i-H_X^35_ 

•ooooooooooooooooooo 


rH^r-rr-TcO  i-To^r-Tr-r. 


iM  rH  i-l         1-1 


OOOOOOOOOOOOOOOOOOO 


Cil^f-<CiOi-i'*<O«CiT-HCC!00CqQ0C0 


CO  CO 


CO  CO  uo  l^  1 


CO  CO  "M  <-H  t^  "*  uo  cc  o  ^  1^  cq  Ci  >-(  uo  i-o  -t*  1-1  Ci 
oo  uo  Ci  1^  Tti  lo  1— I  -^  o  Ci  CO  C5  CI  -— < .— ( 1— I  crs  i-c  i-o 

O^C<J^O^^^C^^-<^^O^l>;_rH00^'O^t^^C0^O_C:5^Ci_C0_C0^O^ 

ijrrco~o"Tjro"i^irri--^'*"crcrr-r-^-H~<:c~co~o~t-^'i^ 

uOi-lCiGO:OCO<MXOOCOCOOO(>JCN(MaOiOGO 
l-0i-lC^'^C<jL-0r-(rHi-HU0<X)rHC0C0  1.^C0l^rfl.-( 


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.S.i;  o 


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65 


to    1,008 
to    1,134 
to       842 
to    2,320 
to  10,622 

•jDC>.OOeOCOCOC>-^^>OirOMr^O 
^S^S^IoO^OoS  ^^CO  O  lO  I- 

sssssssssssssss 

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SS3SSSSSSS 

Tt"  i>-  o         00  0^  xi  t-:,i^^'-<  '-i"*  i^  '^^i^  ^Si"^  "^ 

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,-lt-OC3C:C:x<Ml-CiC0i0  1^t-C0 

85  i5  ?5  5?  .^  ^r^  i^  .X  g  q,t ^A^.-. 

SSSBSSSSBSSSBSS 

Lto    1,815 
L  to    1,017 
lto    1,084 
I  to    1,035 
Lto    1,882 

CO^ 

CO 

s 

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.-1                 r-l  C--J 

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to    1,456 
to    8,379 
to    1,362 
to    4,392 
L  to  21,246 

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I— 1 1—1 

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66 


Table, 


Showing  the  Pojmlation,  with  numh'ers  and  proportions  of  Insane  and  Idiots^ 
Classified  according  to  Race,  in  the  United  States  in  1870. 


KACE. 

Population. 

Insane. 

Idiotic. 

li 

Total  of  Insane 
and  Idiotic 

Eatio  of  Insane 
and  Idiotic  to 
Population. . . 

•White? 

33,586,989 

4,880,009 

62,254 

25,731 

35,560 

1,774 

35 

13 

21,324 

3,188 

5 

10 

1  to     944 
1  to  2,750 
1  to  1,807 
1  to  1,979 

Ito   1,579 
Ito   1,530 
1  to  12,450 
Ito   2,573 

56,884 

4,962 

40 

23 

1  to     590 

Colored      

1  to     983 

Chinese 

1  to  1,556 
1  to  1,118 

Indians  

Nevada  will  of  course  come  out  with  flying  colors,  since  all  of  the 
insane  of  that  State,  with  two  exceptions,  have  been  credited  to  us.  As 
the  table  shows  a  larger  projDortion  of  the  insane  to  population  in  the 
District  of  Columbia  than  in  almost  any  other  community  in  the  world — - 
being  one  to  two  hundred  and  forty-eight — we  deem  it  not  only  just,  but 
proper,  to  show  why  this  is  so.  The  Government  Asylum,  located  in 
the  District,  is  not  only  intended  for  those  who  reside  within  its  limits, 
but  also  for  the  soldiers  and  sailors  of  the  army  and  navy  of  the  United 
States;  and  as  these  are  brought  from  all  parts  of  the  Union,  of  course 
the  list  is  swelled  far  beyond  the  ordinary  pro2)ortion  in  other  communi- 
ties. The  causes  leading  to  the  rapid  development  of  insanity  in  this 
State  will  be  considered  in  relation  to  other  matters  pertaining  to  Cali- 
fornia. 


CHAPTEE  YII. 


IIS^SANITY  IN  FEANCE— GENEEAL  STATISTICS  OF  THE  INSANE  FEOM 
1854  TO  1866— DE.  MOTET'S  ANALYSIS  OF  LEGOYT'S  WOEK. 


Having  alluded  in  the  preceding  Chapter  to  the  imperfect  manner  in 
which  the  insane  in  France  had  been  enumerated,  even  at  so  late  a  date 
as  eighteen  hundred  and  fifty,  we  take  pleasure  in  laying  before  our 
readers  the  following  able  and  interesting  analysis  of  M.  Legoyt's  great 
work  on  the  Statistics  of  the  Insane,  by  Dr.  Motet,  Secretary  of  the 
Medico-Psychological  Society  of  France,  who  kindly  presented  us  with  a 
copy. 

This  able  review  of  one  of  the  most  important  public  documents  ever 
published  in  France  cannot  fail  to  interest  and  instruct  all  who  read  it. 
We  believe  it  gives  a  better  idea  and  affords  a  more  comprehensive  view 
of  the  number  and  condition  of  the  insane  in  France  than  any  work  that 
has  hitherto  been  offered  in  the  English  language;  and  though  it  treats 
of  some  topics  upon  which  we  have  already  touched  it  is  given  entire: 


67 

DR.    motet's   analysis    OF  LEGOYT'S   WORK  * 

The  subject  of  insanity  has  for  some  time  actively  interested  the 
French  mind.  People  are  now  no  longer  satisfied  with  barren  sympathy; 
they  question,  they  are  anxious.  Each  one  imagines  it  his  right  and  his 
duty  to  probe  this'deep  wound  of  society,  and  doubtless  with  a  laudable, 
but  sometimes  inopportune  zeal,  reforms  are  proposed  on  all  sides;  an 
almost  radical  modification  of  the  legislation  which  here  regulates  the 
condition  of  the  insane  is  desired.  A  word  which  in  our  country  is 
never  uttered  without  exciting  a  tumult — liberty — is  the  watchword  at 
which  rally  a  great  number  of  writers  who  lack  only  one  thing,  a  little 
experience.  To  these  publicists  who  are  animated  by  the  best  inten- 
tions, we  will  not  reply  by  cold  disdain-.  We  have  remarked  elsewhere  f 
and  we  gladly  repeat  it  here,  generous  illusions  are  deserving  respect; 
everything  which  relates  to  insanity  acquires  a  dignity,  a  magnitude 
just  m  proportion  to  this  measureless  misfortune,  and  those  who,  excited 
by  a  deep  sympathy,  demand  of  us  by  what  right  we  violently  separate 
from  society  a  being  whose  reason  is  aftected,  deserve  to  be  answered 
not  merely  by  denying  their  competence,  but  by  arguments  and  facts  of 
a  nature  to  justify  our  conduct. 

Moreover,  the  time  has  passed  when  knowledge  was  an  exclusive 
monopolv  in  the  hands  of  a  few.  Social  problems  are  debated  in  open 
day.  AYe  cannot  stay  the  movement  of  thought,  which,  after  all,  tends 
toward  progress;  and  to  be  silent  will  be  to  expose  ourselves  to  deserve 
the  reproach  which,  from  habit,  is  still  easily  enough  addressed  to  us,  of 
seeing  nothing  beyond  a  narrow  specialty.  It  would  be  a  singular  incon- 
sistency for  us  to  refuse  to  examine  the  elements  of  an  investigation 
which  every  one  may  possess.  The  Moniteur  of  April  16,  1866,  published 
a  report  of"  the  Minister  of  Commerce,  the  impression  of  which  cannot 
vet  have  been  eftaced.  These  figures,  which  seem  to  increase  each  year, 
and  which  statistics  present  from  time  to  time  to  the  impatient  but  legiti- 
mate curiosity  of  economists  and  philanthropists,  need  to  be  commented 
on  and  discussed;  what  is  of  especial  importance  is  to  give  them  a  correct 
interpretation,  and,  accepting  them  as  the  stern  expression  of  facts  unfor- 
tunately too  true,  not  to  force  results  from  them — not  to  deduce  too 
hasty,  and  therefore,  very  probabl}',  erroneous  conclusions  from  them. 
Many  minds,  even  the  best,  accepting  them  without  question,  and  seduced 
by  their  eloquence  (the  expression  is  restricted  to  a  particular  signifi- 
cation), imagine  it  their  duty  to  take  up  arms  against  us.  Although 
silence  sometimes  serves  a  just  cause  better  than  too  much  discussion,  it 
seems  to  us  that  we  ought  not  to  be  silent  to-day.  We  have  at  our  com- 
mand the  elements  which  are  always  wanting  to  those  who  can  only 
make  abstracts  of  accounts.  Is  it  that  we  consider  fruitless  those  patient 
investigations  which  present  to  us,  at  stated  periods,  the  balance  of  our 
intellectual  and  moral  condition?  Such  is  not  our  idea.  We  well  know 
(for  we  have  been  aided  by  it)  what  labor  and  research  have  been 
necessary  to  present  at  once  the  imposing  array  of  figures  wdiich  consti- 
tutes the  statistics  of  the  insane  in  France  from  1854  to  1860.  M.  Legoyt 
possesses  a  thorough  experience  in  these  matters,  and  we  are  merely 
just  in  tendering  to  him  here  the  tribute  of  praise  which  he  deserves: 


*  Translated  by  Miss  Martha  W.  Sawyer,  Harrison  Square,  Massachusetts. 

t  Of  the  possibility  and  propriety  of  allowing  certain  classes  of  insane  to  leave  special 
asylums  and  of  placing  them  either  at  agricultural  improvement  or  with  their  own  families. 
(Medical  Congress  at  Lyons,  1864);  (The  Insane  before  the  Law).    Paris,  1866. 


68 

he  has  well  completed  a  thankless  task,  the  scattered  materials  for  which 
would  have  remained  in  confusion  if  he  had  not  collected  them,  sul'Sti- 
tuting  in  place  of  chaos  a  fruitful  harmony.  It  is  not,  then,  a  criticism 
which  we  are  about  to  make;  it  is  a  complement  of  instruction  which 
we  would  present.  To  harsh  figures  we  would  oppose  facts;  what  seems 
to  us  important  is  to  explain  how  results,  apparently  deplorable,  are  due 
to  the  influence  of  causes  very  readily  appreciable;  in  short,  to  solve  a 
question  which  has  been  put  to  us,  and  which,  in  our  opinion,  will  place 
us  in  a  most  humiliating  situation  if  we  leave  it  unanswered. 

The  sequestration  of  the  insane  in  public  or  private  as^dums  is,  at  the 
same  time,  a  measure  of  i^ublic  order  and  of  personal  safety.  The  lunatic 
is  a  sick  person  who  has  the  right,  by  very  reason  of  the  special  disease 
with  which  he  is  aft'ected,  to  special  care;  he  is  also  a  being  dangerous 
to  those  around  him;  in  presence  of  this  terrible  scourge,  the  most  pre- 
possessed minds  cannot  refuse  to  admit  it,  family  devotion  is,  for  the 
most  part,  fruitless;  they  are  exhausted  by  vain  efforts;  the  most  gen- 
erous sacrifices  result  only  in  cruel  deception;  they  are  obliged,  sooner 
or  later,  to  adopt  the  serious  measure  of  placing  in  an  asjdum  the  patient 
whom  they  can  neither  protect  nor  take  care  of  at  home.  ^Ye  under- 
stand too  well  how  serious  are  the  questions  which  sequestration  in- 
volves, even  when  it  is  most  justifiable,  to  seek  always  to  hasten  it. 
Although  cure  is  a  performance  too  often  compromised  by  unwise  delay, 
we  are  but  feebly  disposed  to  blame  the  family  affection  which  resists 
our  advice  and  waits  until  the  last  moment  to  take  leave;  but  we  do  not 
hesitate  to  blame  those  who  entertain  unjust  suspicions  and  represent 
the  asylum  as  the  sepulchre  of  intelligence.  It  is  too  lightly  flinging 
the  shroud  over  the  head  of  the  dying;  it  is  too  seriously  undervalueing 
the  wisdom  and  the  honor  of  the  physicians  who  devote  themselves  to  a 
task  always  sad.  The  lunatic  is  not  fatally  condemned  to  leave  the  little 
reason  which  still  remains  in  those  establishments  which  the  vivid  imag- 
inations of  some  philanthropists  transform  into  a  kind  of  extinguisher. 
There  is  something  better  to  be  done  than  to  address  petitions  to  the 
Senate;  it  is  necessary  to  give  an  account  of  things,  not  to  seize,  with 
unreflecting  haste,  the  maticious  lucubrations  of  unfortunate  minds  still 
affected,  although  they  may  present  the  fairest  appearance.  But  to 
restrain  impulse  in  France  would  be  to  reform  our  national  character, 
and  although  these  excesses  may  not  be  to  our  taste,  they  have,  as  a 
point  of  departure,  a  sentiment  so  elevated  as  to  merit  being  reduced  to 
their  just  value  without  passion  on  our  part;  we  have,  moreover,  good 
reasons  enough  to  produce  to  maintain,  without  fear,  an  attitude  of 
defense,  and  never  to  attempt  to  assume  an  aggressive  attitude  towards 
those  who  try  to  save,  by  a  bold  couj)  de  'main,  their  compromised  cause. 
We  shall  proceed  in  this  matter  in  a  calmer  way,  consulting  rather  the 
experience  of  our  predecessors  than  our  own;  but,  nevertheless,  we  do 
not  wish  to  be  hastdy  accused,  or  to  have  it  thought  that  we  have  gained 
nothing  during  thirty  years.  We  do  not  think,  whatever  may  be  said, 
that  we  are  behind  neighboring  nations;  our  legislation,  if  it  is  not  per- 
fect, does  not  deserve  the  reproach  which  it  receives,  of  being,  the  greater 
part  of  the  time,  insutncient  or  arbitrary.  One  cannot  den}',  without 
systematically  closing  his  eyes  to  evidence,  that  nowhere  is  the  solicitude 
of  the  State,  of  the  Government,  more  active  than  in  our  country.  AVe 
find  a  proof  in  these  statements  which  we  now  possess,  and  which  we 
wish  to  explain  to  all.  We  have  been  preceded  in  this  design  by  our 
learned  colleague,  Dr.  Brierrc  de  Boismont,  who  published  in  this  coUec- 


69 

tion  an  excellent  analysis  of  the  statistical  works  of  M.  Legoyt.**  Wo 
cannot  do  better  than  to  follow  his  steps;  finding  ourselves,  moreover, 
in  perfect  conformity  with  his  vicAvs,  we  shall  be  obliged  to  refer  to 
points  already  noticed  by  him. 

The  number  of  establishments,  public  and  private,  devoted  to  tho 
insane  was  one  hundred  and  eleven  in  eighteen  hundred  and  fifty -three. 
At  the  close  of  eighteen  hundred  and  sixty  there  were  only  ninety-nine, 
as  several  of  them  may  have  been  sujipressed  on  account  of  their  trifling 
importance  or  of  their  incomplete  or  irregular  organization.  On  tho 
first  of  January,  eighteen  hundred  and  fifty-lour,  their  population  was 
twenty-four  thousand  five  hundred  and  twenty-four  lunatics  of  both 
sexes.  This  number  increased  in  the  succeeding  years,  but  the  progres- 
sion has  been  much  less  rapid  than  in  the  period  between  eighteen  hun- 
dred and  thirty-five  and  eighteen  hundred  and  fifty-three.  The  follow- 
ing table  will  show  this: 


January  1st,  1854 !      24,524 

January  1st,  1855 1      24,896 

January  1st,  1856 

Januar}'  1st,  1857 

January  1st,  1858 

January  1st,  1859 

January  1st,  1860 

January  1st,  18G1 


25,485 
26,305 
27,028 
27,878 
28,761 
30,239 


The  increase  was  enormous  from  eighteen  hundred  and  thirty  six  to 
eighteen  hundred  and  forty-six,  each  quinquennial  period  presenting  an 
increase  of  five  and  a  half  per  cent;  but  since  eighteen  hundred  and 
forty-six  the  progression  has  been  greatly  diminished.     It  appears: 


From  1846  to  1851. 
From  1851  to  1856. 
From  1856  to  1861. 


3.71  per  cent. 
3  87  per  cent. 
3.14  per  cent. 


These  results  should  not  astonish.  The  increase  in  the  population  of 
asylums  corresponds  to  the  relief  which  they  bring  to  the  lot  of  the 
insane — a  new  organization,  in  which  much  more  attention  is  given  to 
the  conditions  of  material  life  of  the  patients  than  formerly.  On  the 
other  hand,  the  foundation  of  new  estabUshments;  the  confidence  in- 
spired by  officers  and  physicians;  and,  it  must  be  allowed  also,  the 
greater  facility  of  communication.  The  changes  brought  about  within 
thirty  years  in  our  customs,  in  our  needs,  all  favored  this  movement  of 
entry.  It  was  the  necessary  result,  foreseen  in  advance,  of  a  new  order 
of  things.  Now  the  equilibrium  tends  to  become  reestablished,  and  we 
doubt  not  that  from  this  time  for  some  years  a  sensible  diminution  will 
be  proved  in  the  still  continuous  increase  of  which  statistics  accuse  us. 
Everything  has  contributed  to  increase  these  numbers;  and  it  is  from 
settled  convictions  that  we  assert  that  there  has  not  actually  been  the 


*Annals  of  Public  Hygiene  and  Legal  Medicine,  Second  Series,  vol.xi,  p.  197.    Motet. 


70 

enormous  increase  which  is  indicated.  The  investigations  have  been 
more  carefully  made  during  these  last  ten  years  than  they  had  ever 
been.  Those  of  whom  information  was  sought  understood  the  import- 
ance of  such  work,  and  the  French  Statistical  Bureau  has  been  able  to 
collect  materials  much  more  complete  than  those  heretofore  placed  at 
its  disposal.  This  result,  the  extent  of  which  will  be  better  appreciated 
in  the  future,  is  due  to  the  active  and  persevering  energy  with  which 
M.  Legoyt  has  inspired  every  department  of  his  administration. 

If  the  population  of  the  asylums  increases,  the  proportion  of  the 
insane  in  relation  to  the  population  of  France  ought  also  to  increase; 
but  it  is  imj^ortant  constantly  to  bear  in  mind,  in  presence  of  these 
figures,  the  increased  extent  each  year  of  public  assistance;  more 
patients  relieved  and  treated;  that  is  all  which  can  be  deduced  from 
them.     Thus  it  is  estimated  in 


Tear. 


Population  of  France. 


Insane  Under 
Treatment. 


Proportion  to  Population. 


1851 
1856 
1861 


35.783.170 
36.139.364 
36'717,254 


21.353 
25,485 
30,239 


1  to  1,676  inhabitants. 
1  to  1,418  inhabitants. 
1  to  1.214  inhabitants. 


This  is  not  the  exact  proportion  of  the  insane  to  the  total  population 
of  the  Empire;  we  must  add  the  insane  remaining  in  families,  of  Avhich 
the  number  was  in  eighteen  hundred  and  fifty  four  neiirly  twenty-four 
thousand  four  hundred  and  thirty-three  individuals;  in  eighteen  hundred 
and  fifty-six.  thirty-four  thousand  and  four;  in  eighteen  hundred  and 
sixty-one,  fifty-three  thousand  one  hundred  and  sixty — which  makes  for 
this  last  year,  including  the  insane  treated  in  asylums,  about  two  insane 
to  one  thousand  inhabitants.  To  what,  then,  is  this  increase  due?  To 
the  idiots  and  cretins  being  included  in  the  statistical  tables,  and  it  is 
impossible  on  seeing  their  number  "increase  from  twenty-five  thousand 
two  hundred  and  fifty-nine  in  eighteen  hundred  and  fifty-six  to  forty- 
one  thousand  five  hundred  and  twenty-five  in  eighteen  hundred  and 
sixty-one,  not  to  conclude,  as  M.  Legoyt  has  judiciously  done,  that  there 
was  a  serious  error,  the  more  easily  committed  since  the  greater  part  of 
the  idiots  and  cretins  remain  at  home;  since  previous  to  eighteen  hun- 
dred and  sixty- one  they  were  confounded  with  the  general  population, 
and  since,  if  in  accordance  with  the  more  complete  instructions  given 
to  the  Census  Marshals,  they  have  been  classed  apart,  it  is  not  surprising 
that  results  so  difterent  in  apjDcarance  have  been  obtained.  This  reason 
(a  more  rigid,  more  exact  appreciation  of  mental  condition)  should  be  the 
true  one. 

It  is  scarcely  probable  that  the  number  of  idiots  increased  everywhere 
at  once.  But  one  thing  is  certain,  that  in  eighteen  hundred  and  fifty-six 
there  were  only  two  thousand  eight  hundred  and  forty  idiots  in  the 
asylums,  and  in  eighteen  hundred  and  sixty-one  three  thousand  seven 
hundred  and  forty-six  of  them  were  counted.  The  influence  of  Ferrus 
had  made  itself  felt;  he  had,  in  a  remarkable  rej)ort,  described  the  incon- 
venience which  might  arise  by  withdrawing  imbeciles  and  idiots  from 
the  action  of  the  law,  and  the  administrative  power  had  adopted  his 
views.     The  number  would  have  increased  much  more  if  they  had  not 


71 

made  so  great  a  restriction  in  the  admission  of  idiots.  It  would  doubtless 
be  desirable  that  all  who  belong  to  indigent  families  should  be  effectually 
relieved.  There  is,  in  this  way,  a  progress  to  be  effected,  and  some 
efforts  have  already  been  made;  but  it  is  difftcult  to  think  of  j^lacing 
indefinitely  in  an  asjdum  inoftensive  beings  who  live  a  wholly  vegeta- 
tive life.  It  is  at  the  same  time  imposing  too  heavy  a  tax  upon  the 
department,  and,  on  the  other  hand,  increasing  a  burden  which  is  already 
too  real  in  a  large  number  of  our  asylums.  Moreover,  under  the  general 
name  of  idiots'is  included  a  class  of  beings  who  are  not  entirely  useless. 
There  are  imbeciles,  feeble  minded,  as  they  are  called  in  some  localities, 
who  are  good  workers  and  who  regularly  accomplish  a  slightly  compli- 
cated task.  Until  now  they  have  been  unnoticed  in  statistical  state- 
ments; they  apjDcar  there  now,  and  augment  by  so  much  the  total 
humber.  The  situation  is  not  then  so  deplorable  as  might  have  been 
suj^posed,  and  we  believe  that  the  deviation  will  be  much  less  for  several 
years  from  now. 

AYhat  we  have  remarked  concerning  the  influence  of  the  reorganiza- 
tion of  asylums  upon  the  increasing  number  of  insane  under  treatment 
is  especially  noticeable  in  the  statements  of  the  admissions.  One  is  con- 
vinced, by  consulting  them,  that  the  greatest  increase  corresponds  to  the 
period  nearest  to  the  promulgation  of  the  law  of  eighteen  hundred  and 
thirty-eight.  M.  Legoyt  divides  the  period  from  eighteen  hundred  and 
thirty-five  to  eighteen  hundred  and  sixty  into  five  sub-periods,  and  he 
finds  that  the  proportional  increase  has  beeUj^annually: 


< 

YEAKS. 

Per  ct. 

From  1840  to  1844 

7  94 

From  1845  to  1849 

3.38 

From  1850  to  1854 

3  83 

From  1855  to  18G0 

2  00 

Here  is  also  the  exact  number  of  admissions  from  1854  to  1860: 


1855 

9,303 

9,246 

10,024 

1858 

10,314 
10  086 

1856 

1859.. 

1857 

I860 

10  785 

Which  gives,  as  the  annual  mean  of  admissions,  about  nine  thousand 
three  hundred  and  fifty-three  insane,  seven  hundred  and  twenty-seven 
idiots,  and  eleven  cretins  ;  hence,  of  one  hundred  j^atients  admitted, 
there   were  ninety -two  insane,  seven  idiots,  and  one  cretin. 

The  admissions  are  voluntary,  that  is  to  say,  requested  by  the  families, 
or  officially  ordered  by  the  authorities.  The  tables  which  we  have  here 
do  not  make  a  distinction  which  is,  nevertheless,  of  some  imj^ortance. 
Nearly  two  thirds  of  the  admissions  into  the  departmental  asylums  are 
made  officially;  in  the  departments  for  pensionnaires,  in  the  private  insti- 
tutions, including  Charenton,  there  is  nothing  like  it.  This  occurs, 
doubtless,  from  the  negligence  of  the  families  of  the  indigent  insane, 


72 

from  the  slighter  disturbance  of  private  interests  which  the  presence  of 
an  insane  person  creates,  and  also  from  prejudices  which  have  not  yet 
entirely  disappeared  among  the  poorer  classes,  and  which  are  no  longer 
shared  by  the  better  educated  classes.     The  voluntary  entries  were: 


In  1856  in  the  proportion  of. '  30.20  percent. 

In  1857  in  the  proportion  of '  ,31.19  percent. 

In  1858  in  the  proj^ortion  of. :  32.02  percent. 

In  1859  in  the  proportion  of |  30. Gl  percent. 

In  1860  in  the  proportion  of j  32.02  percent. 

! 

The  official  entries  were: 


In  1856  in  the  j^roportion  of j  69.80  per  cent. 

In  1857  in  the  proportion  of \  68.81  per  cent. 

In  1858  in  the  proportion  of i  67.98  per  cent. 

In  1859  in  the  proportion  of. !  69.39  per  cent. 

In  1860  in  the  proportion  of. j  67.98  per  cent. 


In  wealthier  families,  w^ere  the  physician  is  called,  if  not  at  the  com- 
mencement of  the  insanity,  at  least  as  soon  as  it  becomes  serious,  the 
situation  is  different.  Judicious  advice  is  given  and  often  promptly  fol- 
lowed. They  do  not  wait  for  the  interference  of  the  authorities  to  effect 
an  entry;  they  hope,  on  the  contrary,  that  by  combating  the  disease  in 
season  they  will  have  better  opportunities  of  eradicating  it,  and  the 
official  entry,  which  is  so  common  to  asylums,  becomes  almost  the  excep- 
tion in  private  establishments.  This  may  be  seen  by  the  following  fig- 
ures, which  are  a  statement  of  the  admissions  into  the  hospital  (^maison 
de  sante)  directed  by  Dr.  3Iesuet  and  myself: 


1856 — 54  admissions,  of  which  9  were  official '  16.65  per  cent. 

1857 — 68  admissions,* of  which  8  were  official 11.76  per  cent. 

1858 — 74  admissions,  of  which  9  were  official :  12.15  per  cent. 

1859 — 74  admissions,  of  which  7  were  official I  9.45  per  cent. 

I860 — 54  admissions,  of  which  4  were  official ,  7.40  per  cent. 

1861 — 59  admissions,  of  which  4  were  official |  7.14  per  cent. 

. L__ ^__ 

No  other  conclusion  of  interest  can  be  drawn  from  it;  in  the  asylums 
the  entries,  which  are,  after  all,  a  kind  of  public  assistance,  should  be 
under  the  supervision  of  the  administrative  power,  and  the  right  of  con- 
trol which  it  reserves  is  not  excessive.  It  is  known,  moreover,  that  it 
never  refuses  to  open  the  doors  of  its  special  establishments  when  a 
request  really  justifiable  is  made;  the  entry,  which,  for  j^aupers,  is  always 
made  by  means  of  the  authorities,  takes  the  name  of  official  entry  for 
that  reason;  but,  if  we  except  insane  vagabonds,  incendiaries,  and  homi- 
cides, the  .Mayors  and  Prefects  never  make  the  decision  before  having 
been  sought  by  the  Aimily.  One  need  not,  then,  infer  from  these  figures 
(which  might  at  first  surprise)  too  frequent  or  too  great  an  intermeddling 


73 

of  the  iidmmistration  in  the  sequestration  of  the  insane.  For  the  large 
towns,  which,  lilve  Paris,  have  private  hospitals,  the  official  entries  have 
taken  place  only  in  desperate  cases;  and  when  an  insane  person  has 
been  arrested  upon  the  highway  his  family  is  immediately  notified,  if 
possible,  and  invited  to  designate  the  establishment  in  which  they  wish 
the  patient  to  be  entered.  ^  At  Paris,  it  is  the  Prefect  of  Police  who 
makes  the  arrest.  He  uses  the  right  which  the  law  gives  him  to  protect 
public  order  and  personal  safety,  and  one  cannot  complain  when  authority 
takes  the  place  of  an  absent  or  negligent  family.  We  insist  upon  this 
point,  for  this  right  of  authority  is  now  contested  with  more  passion 
than  'propriety;  If  all  the  difficulties,  all  the  embarrassments  which  are 
constantly  created  by  the  insane  in  society  w^ere  well  understood;  if  the 
consequences  of  their  acts  were  examined  without  prejudice,  and  inter- 
vention always  useful,  never  arbitrary,  would  perhaps  be  less  promptly 
censured.  And  allow  us  to  say,  there  are  insane  and  idiots  for  whom 
sequestration  in  an  asylum  w^ould  be  a  blessing;  they  would  escape  ill 
treatment,  detestable  calculations  dictated  by  base  cupidity;  recent  facts 
which  have  been  developed  by  tribunals  have  shown  but  too  well  how 
far  cruelty  and  ill  usage  of  poor,  defenceless  beings  may  be  carried. 
We  believe,  therefore,  that  it  is  well  to  leave  to  the  Mayors  and  Pre- 
fects the  liberty  of  the  initiative,  and  that  to  withdraw  it  would  be  to 
promote  the  development  of  abuses  already  but  too  common. 

The  number  of  women  in  the  asylums  is  always  a  little  larger  than 
of  the  men,  and  nevertheless  the  admissions  are  in  an  inverse  propor- 
tion. The  reason  of  this  fact  is  that  the  discharges  and  deaths,  and  the 
mean  length  of  residence,  differ  much  for  the  two  sexes.  The  mortality 
and  the  discharges  attain  a  higher  figure  among  males  than  femak  s.  Wo 
shall  refer  again  to  this  subject.  The  following  are  the  figures  corres- 
ponding to  the  period  eighteen  hundred  and  fifty -four  to  eighteen  hun- 
dred and  sixty,  for  the  patients  present  at  the  end  of  each  year: 


YEAK. 

Males. 

Females. 

1QFS4.                                        

12,036 
12,221 
12,632 
12,930 
'        13,392 
13,876 
14,582 

12,860 

i«55                         

13,264 

1856           ..          

13,673 

i«^7 

14,098 

1  «5«                     

14,486 

1859                 

14,885 

IQf^O                                

15,657 

This  difference  had  been  already  noted  from  eighteen  hundred  and 
forty-two  to  eighteen  hundred  and"  fifty-four.  The  proportion  was,  per 
hundred,  forty-seven  and  seventy-seven  one  hundredths  males,  and  fitty- 
two  and  twenty-three  one  hundredths  females.  From  eighteen  hundred 
and  fifty-four  to  eighteen  hundred  and  sixty  it  is  nearly  the  same,  for  we 
find  among  one  hundred  patients  forty-eight  and  ten  one  ^hundredths 
males,  and  fifty-one  and  ninety  one  hundredths  females.  This  is  not  the 
case  among  idiots  and  cretins.  Subtracting  these  from  the  total  num- 
ber of  insane  under  treatment,  we  find  among  one  hundred  idiots  and 


10 


74 

cretins  fifty-one  and  twenty-two  one  hundredths  males,  and  forty-eiglit 
and  seventj'-eight  one  hundredths  females. 

One  of  the  most  interesting  subjects  of  study  is  that  of  the  curability 
or  incurabilit}^  of  the  insane  under  treatment.  But  who  does  not  com- 
prehend at  the  same  time  how  researches  of  this  nature  must  lack 
correctness?  Let  us,  therefore,  attach  but  an  indifferent  importance  to 
the  figures  furnished  us  by  statistics.  They  are  approximate  results, 
which  could  only  acquire  a  real  value  in  case  it  were  possible  to  estimate 
singly  the  statistics  of  each  asylum  after  having  deducted  from  its  lists 
the  epileptic,  the  paralytic  imbeciles  (les  dements  paralytiques),  the  idiots 
and  the  cretins,  for  whom  incurability'  is  no  longer  a  presumption,  but  a 
certainty.  We  shall  not  insist  upon  this  j^oint;  when  the  discharges  by 
recovery  are  presented  to  us  we  shall  find  more  exact  means  of  estima- 
tion, and  such  as  will  better  merit  our  consideration. 

At  what  age  is  insanity  most  common?  Statistics  previous  to  eighteen 
hundred  and  fifty-four  agree  with  those  which  have  just  been  published; 
it  is  from  thirty-five  to  forty  years  that  we  find  the  most  insane  of  both 
sexes.  It  is  likewise  the  period  of  life  at  which  males  and  females 
expend  the  most  physical  and  intellectual  activity.  It  is  the  age  of 
comj^lete  development;  it  is  also  that  at  which  trials  are  most  numerous. 
Thus  of  seven  thousand  two  hundred  and  ninety-two  insane  persons 
admitted  (mean  year)  for  the  first  time,  from  eighteen  hundred  and  fifty- 
six  to  eighteen  hundred  and  sixty,  we  find: 


TEAKS. 

1 
Males,        Females. 

Total. 

From  20  to  30  years 

762 
1,107 

857 

688 
888 
676 

■ 
1,450 
1,995 
1.533 

From  30  to  40  vears 

From  40  to  50  vears 

Beyond  this  period  of  life  the  proportion  of  females  increases;  at  a 
single  period  there  is  almost  an  equality;  it  is  from  fifty  to  fifty-five 
years — we  find  four  hundred  and  ninety-five  males  and  four  hundred 


and  fifty-eight  females. 


YEAES. 

Males. 

Females. 

Tot^l. 

From  60  to  70  years 

243 
101 

324 

182 

567 

Above  70  years 

283 

Among  idiots  and  cretins  it  is  from  twenty  to  thirty  years  that  the 
greatest  number  of  admissions  takes  place.  That  is  readily  understood; 
it  is  the  time  at  which  these  unfortunates  become  most  troublesome  to 
the  family. and  to  society,  especially  those  whose  j)hysical  development 
is  not  too  incomj)lete,  and  who  manifest  all  sorts  of  imj^ulses — blind 
passions  which  it  is  often  difficult  to  control.  What  is  the  result  in  the 
families  of  these  poor  creatures  for  whom  constant  Avatchfuluess  is  neces- 
sary, and  who  become  a  deeper  and  deeper  source  of  anxiety?     They 


75 


embarrass  labor  and  they  oppress  by  too  heavy  a  tax  an  account  already 
limited;  it  becomes  necessary  to  part  with  them,  and  to  ask  their  admis- 
sion into  the  asylum.  Above  fifty  years  the  number  of  admissions  is 
reduced  a  little;  it  might  descend  to  zero  without  our  being-  astonished, 
for  idiots  rarely  live  to  that  age;  it  seems  probable  to  us  that  they  must 
have  inserted  in  the  table  individuals  who  are  only  imbeciles;  for  the 
latter,  indeed,  the  duration  of  life  is  more  extended  than  for  idiots. 

The  civil  condition  of  the  insane  admitted  for  the  first  time,  from 
eighteen  hundred  and  fifty-six  to  eighteen  hundred  and  sixty,  has  been 
stated  most  carefully,  and  offers  us  the  following  results: 


Males. 

Females. 

Total. 

9,545 

7,731 

1,327 

545 

7,624 
6,671 

2,718 
298 

17,169 

IVfjl  TTI  pd                                           

14,402 

AVirlnwpi'*^  nnd  "widows 

4,045 

r^ivil  r'on(]ition  unknown      

843 

Totals            i 

19,148 

17,311 

36,459 

The  number  of  unmarried  insane  is  of  itself  as  considerable  as  that  of 
the  married  and  widowed  insane.  All  statistics  agree  upon  this  point. 
Is  it  because  celibacy  predisposes  one  to  insanity?  This  problem  has 
long  been  agitated,  and  the  solutions  are  various.  An  unmarried  person 
retains  a  greater  freedom  to  temptation,  and  he  yields  more  readily  to 
those  allurements  which  family  relations  diminish,  if  they  do  not  entirely 
efface;  life  is  less  regular,  less  calm;  in  trial  it  is  less  encouraged,  less 
supported,  and  having,  generally,  no  one  near  to  care  for  him  if  attacked 
by  insanity,  the  doors  of  the  asylum  or  of  the  hospital  will  open  far 
more  readily  to  him  than  to  any  other.  The  causes  of  the  numerical 
superiority  of  unmarried  persons  in  the  admission  are  therefore  complex. 
They  have  not  escaped  the  sagacity  of  M.  Legoyt,  who  has  judiciously 
described  them.  As  to  Avidowhood*  it  seems  to  exercise  a  more  unfavor- 
able influence  upon  females  than  upon  males;  but  to  make  a  correct 
estimate  it  is  necessary  to  find  out  whether  women  do  not  oftener  remain 
in  the  condition  of  widowhood  than  men,  and  whether,  also,  the  moral 
causes  do  not  play  the  most  important  part  in  these  new  conditions. 

As  for  the  preceding  statistics,  the  examination  of  the  professions  fur- 
nishes a  sad  lesson.  ^It  is  from  among  the  laborers  of  thought  that 
insanity  receives  most  victims.f  For  the  period  included  between  eigh- 
teen hundred  and  fifty-four  and  eighteen  hundred  and  sixty  these  state- 
ments give  the  enormous  number  of  forty-six  hundred  and  twenty  per- 
sons engaged  in  the  liberal  professions.  Compared  with  the  total  num- 
ber of  admissions  this  result  presents  a  proportion  of  ten  per  cent.  See 
the  following  table: 


*I  have  no  English  word  more  nearly  corresponding  to  "veuvage"  than  widowhood, 
which  I  use  for  both  sexes. 

t  Our  investigations  lead  us  to  believe  the  reverse  of  this  to  be- true  in  all  other  countries 
than  France. 


76 


TEAKS. 

Number  en- 
gaged      in 
the  Liberal 
Professions 

1854  to  1855 

1,839 
511 

1856 

1857 

544 

1858 

497 

1859 

658 

1860 -  - 

571 

Total 

4,620 

During  the  same  time  there  were  sixty-eight  thousand  nine  hundred 
and  ninety-two  admissions.  If  in  round  numbers  we  deduct  twenty 
thousand  idiots  and  cretins,  there  remain  forty-eight  thousand  nine  hun- 
dred and  ninety-two  admissions,  of  which  four  thousand  six  hundred 
and  twenty  represent  individuals  having  received  a  liberal  education. 
Clergymen  and  members  of  religious  orders  amount  to  twelve  hundred 
and  forty-eight;  physicians,  apothecaries,  and  midwives,  to  six  hundred 
and  thirty-three;  professors,  learned  men,  and  men  of  letters,  one  thou- 
sand and  ninety-three;  artists,  sculj^tors.  painters,  musicians,  eight  hun- 
dred and  sixty.  The  rest  of  the  catalogiie  are  notaries,  advocates, 
bailiffs,  and  public  officers  or  employes.  The  other  professions  are  far 
from  furnishing  so  large  a  quota.  This  is,  as  M.  Brierre  de  Boismont 
has  remarked,  another  argument  in  favor  of  the  opinion  of  those  who 
think  that  the  progress  of  civilization  affects  the  development  of  insanity. 
It  is  just  to  add,  nevertheless,  that  it  is  among  this  class  of  persons 
that  the  excitements  of  life  are  most  incessant,  that  ambition  is  most 
feverish,  and  that  the  sensibilit}^  to  display  constantly  kept  in  exercise 
is  liable  to  the  greatest  extremes.  Military  and  seafaring  men  are  not 
spared;  then  come,  finally,  stockholders  and  proprietors,  the  manual  or 
industrial  professions,  domestics  or  hired  laborers,  and  farmers.  The 
inhabftants  of  towns  constitute  more  than  one  half  the  annual  admis- 
sions, and  yet  the  proportion  of  the  people  of  the  rural  districts  to  those 
of  the  towns  is  as  three  to  one.  There  are  many  causes  which  effect 
this  result.  The  insane  j^erson  is  more  easih^  guarded  in  the  rural 
districts  than  in  towns;  his  presence  in  the  family  does  not  so  necessa- 
rily become  the  occasion  of  difficulties  and  embarrassments  of  all  kinds; 
there  is  more  room  for  him,  and  fewer  causes  of  annoyance;  if  he  is 
sometimes  noisy,  the  neighbors  are  not  disturbed  by  his  cries,  so  he  may 
remain  at  home  a  long  time  if  he  is  inoffensive.  The  citizen,  even  if  he 
were  just  as  docile  and  easily  governed,  becomes,  from  the  fact  of  his 
insanity,  a  source  of  consant  anxiety.  The  asylum  or  private  establish- 
ment which  will  ojDen  its  doors  to  him  will  give  him  a  material  benefit 
which  he  cannot  obtain  at  home,  where,  for  various  reasons,  he  would  be 
habitually  confined  to  his  chamber.  On  the  other  hand,  in  a  family 
whose  means  are  quite  limited  the  incapacity  of  one  of  its  members 
becomes  a  source  oi'  exj^ense  which  the  entry  into  an  asylum  at  the 
present  very  moderate  charge  immediately  reduces.  These  are  constant 
facts,  and  if  we  add  thereto  the  excitements  constantly  renewed,  the 


77 

need  of  luxury  and  more  active  enjoyment,  the  more  frequent  deception, 
the  watchiug,\he  excess,  etc.,  we  shall  understand  the  enormous  dispro- 
portion which  is  presented  to  us  in  the  following  figures: 


185G  to  1860. 


Inhabitants  of  towns 

Inhabitants  of  the  country 
Residence  unknown 

Totils 


18,228 

1(3,914 

1,317 


36,459 


950 

1,481 

98 

2,529 


M.  Brierre  de  Boismont  ascertained  the  same  facts  in  preceding  statis- 
tics, and  the  reasons  by  which  he  supports  them  remain  true  in  our  day. 
There  is  a  perfect  accordance,  just  as  in  the  researches  made  to  ascer- 
tain which  are  the  departments  which  Yurnish  the  most  insane.  They 
are  still  the  Seine,  Seine  Inferieure,  Seine  and  Marne,  the  Khone,  Seine 
et  Oise,  the  Eure,  the  Loiret,  the  Bouches  du  Ehone,  the  Cote  d'Or,  and 
the  Yonne. 

To  conclude  that  which  relates  to  admissions,  we  still  find,  as  in  the 
past,  that  the  Summer  months  are  the  months  of  the  most  numerous 
admissions — that  the  "Winter  months  are  less  fruitful. 

The  study  of  causes  presents  difficulties  of  more  than  one  kind.  We 
must  not  rely  upon  the  very  rigid  estimates  of  statistics  essentially  offi- 
cial. There  is  not  a  physician  having  lived  among  the  insane  who  does 
not  remember  the  extreme  embarrassment  in  which  he  has  often  found 
himself  when  he  has  tried  to  analyze  the  diverse  influences  which  have 
produced  the  development  of  insanity.  It  is  very  rare  to  find  only  one 
of  the  number  to  which  we  can  with  certainty  ascribe  the  actual  de- 
rangement. Be  that  as  it  may,  there  is  a  portion  of  truth  in  the  tables 
which  M.  Legoyt  has  prepared;  and  as  it  was  not  possible  for  him  to 
obtain  more  accurate  statements,  we  will  accept  them.  Among  these 
causes  hereditary  takes  the  lead.  Modern  works,  those  of  Baillarger  in 
particular,  have  represented  its  full  importance.  Of  twenty-eight  thou- 
sand six  hundred  and  twenty-one  insane  of  both  sexes,  of  whom  the 
friends  have  given  the  necessary  information,  there  are  reckoned  four 
thousand  and"  fifty-six  w^hose  father  or  mother  had  been  attacked  by 
insanity;  and  pursuing  the  analysis  still  further,  of  the  insane  admitted 
in  eighteen  hundred  and  fifty-nine  and  eighteen  hundred  and  sixty  it  has 
been  found  that  hereditary  transmission  is  in  some  degree  obedient  to 
the  law  of  propagation  from  sex  to  sex.  The  insane  mother  transmits 
the  insanity  to  her  daughters,  the  father  to  his  sons.  We  reproduce  the 
following  table,  which  relates  to  fifteen  thousand  two  hundred  and  thir- 
teen insane: 


78 


CAUSES. 

Males. 

Females. 

Total. 

Issue  of  an  insane  father ; 

412 
356 

83 
2,367 
4,862 

294 

403 

110 

2,132 

4,194 

706 

Issue  of  an  insane  mother 

759 

Issue  of  an  insane  father  and  mother* 

199 

Issue  of  a  father  and  mother  not  insane. 

Unknown 

4,499 
9,056 

Totals*     

8,080 

7,133 

15  213 

This  gives,  out  of  one  thousand  insane  males,  two  hundred  and  sixty- 
four  bearing  the  hereditary  taint,  one  hundred  and  twenty-eight  from 
the  father's  side,  one  hundred  and  ten  from  the  mother's,  twenty-six 
from  both  sides  at  the  same  time;  of  one  thousand  insane  females,  one 
hundred  from  the  father's  side,  one  hundred  and  thirty  from  the  mother's, 
and  thirty-six  from  both  sides. 

What  is  the  share  of  the  causes  called  physical  and  of  the  moral  causes 
in  the  development  of  insanity?  For  a  great  number,  as  we  have  already 
said,  it  is  very  difficult  to  succeed  in  separating  them  fully.  Sometimes 
they  succeed  each  other  as  consequences  the  one  of  the  other;  some- 
times they  are  so  closely  linked  that  any  distinction  becomes  impossible; 
but  what  is  beyond  doubt  is  that  drunkenness  presents  itself  in  a  great 
number  of  cases.  M.  Brierre  de  Boismont  tried  vainly  to  diminish  its 
influence  Avhen  he  wrote:  "The  man  who  drinks  to  divert  his  thoughts 
from  disappointment,  and  becomes  insane,  has  at  first  acted  under  the 
influence  of  a  moral  cause."  This  reasoning,  which  justly  exhibits  the 
complications  which  may  exist  among  physical  and  moral  causes,  is  only 
applicable  to  a  small  minority.  Xow  that  attention  is  aroused  in  this 
direction,  it  is  beyond  doubt  that  insanity  receives  the  greater  number  of, 
its  victims  from  among  persons  addicted  to  the  use  of  alcoholic  drinks. 
The  nature  of  intoxication,  may  be  curious  to  determine,  for  if  it  is  true 
that,  under  one  form  or  another,  it  is  always  the  alcohol  absorbed  which 
acts  upon  the  cerebral  functions,  it  is  no  less  true  that  certain  prepara- 
tions into  which  it  enters  in  a  highly  concentrated  degree  give  a  more 
rapid  progress  to  the  disease,  and  a  peculiarly  serious  character.  A 
remarkable  fact,  and  one  which  our  personal  researches  have  presented 
in  all  statistical  tables,  is  that  it  is  not  in  wine  countries  that  delirium 
tremens  is  most  frequent.  It  is  in  the  large  towns,  in  cities  where  indus- 
try is  most  developed  and  most  active,  where  there  is  the  greatest 
agglomeration  of  population,  that  delirium  tremens  is  most  common.  It 
is,  moreover,  more  frequently  found  at  the  north  than  at  the  south;  and 
we  do  not  consider  ourselves  guilty  of  exaggeration  in  attributing  to  the 
improvements  made  in  the  distillation  of  beet  root,  potatoes,  and  grains 
a  large  share  of  the  increase  in  the  number  of  the  insane.  One  is  justi- 
fiably startled  at  finding  that  more  than  one  fourth  of  the  persons  whose 
insanity  is  attributed  to  physical  causes  sufi'er  the  penalty  of  alcoholic 
excess.  Of  eight  thousand  seven  hundred  and  ninety-seven  persons, 
three  thousand  and  fourfeen  were  drunkards.     Even  women  pay  their 


*  This  is  a  correct  copy  of  the  figures  presented  in  the  original,  but  there  is  evidently 
an  error,  which  I  conclude  is  in  either  the  males  Or  females  of  the  third  item — eighty-three 
for  eighty-nme,  or  one  hundred  and  ten  for  one  hundred  and  sixteen. 


79 

tribute  to  this  degrading  cause.  They  are,  however,  in  much  smaller 
number — four  hundred  and  forty-one  out  of  seven  thousand  and  sixty- 
nine.  After  this  comes,  in  order  of  frequency,  advanced  age  (I'ago 
avance),  diseases  of  various  organs,  epilepsy,  various  diseases  of  the 
nervous  system.  Onanism  and  venereal  excesses,  destitution  and  misery, 
accidents  and  wounds.  Among  females,  disorders  of  the  genital  organs, 
appearing  either  at  the  time  when  the  uterine  functions  are  most  active 
or  when  they  cease,  are  one  of  the  most  frequent  physical  causes  of 
insanity.  The  proportion  is  one  thousand  five  hundred  and  ninety-two 
out  of  seven  thousand  and  sixty-nine. 

Among  moral  causes,  domestic  disappointment  plays  the  most  impor- 
tant part.  Of  four  thousand  nine  hundred  and  nmeteen  men,  nine  hun- 
dred and  eighty  became  insane  from  this  cause;  of  five  thousand  four 
hundred  and  thirty-eight  women,  one  thousand  five  hundred  and 
sixty-nine  under  the  same  influence.  This  is  a  little  more  than  one 
fourth,  especially  if  we  add  thereto  the  disappointments  resulting  from 
loss  of  friends,  and  which  may,  in  a  great  majority  of  cases,  appear 
among  domestic  disappointments  (chagrins.)  Afterwards  come  disap- 
pointments resulting  from  loss  of  fortune  (851),  from  disappointed  ambi- 
tion (520),  excitement  of  religious  feelings  (1095),  excess  of  intellectual 
labor  (358),  love  (767),  jealousy  (45G),  pride  (368),  anger  (123),  remorse 
(102),  isolation  and  solitude  (115),  simple  imprisonment  (113),  imprison- 
ment in  cell  (26),  nostalgia  (78),  from  a  total  of  ten  thousand  three  hun- 
dred and  fifty-seven  of  both  sexes. 

Under  this  title  ("Aggravating  Circumstances  ")  is  found  one  of  the 
most  instructive  paragraphs  of  all  M.  Legoyt's,  publication.  General 
paralysis  is  there  considered  as  the  complication  of  insanity,  and  its  rela- 
tion to  the  total  poj^ulation  of  the  asylums  is  precisely  stated.  A  com- 
parison between  j^receding  and  present  statistics  jDresents  an  increase 
of  one  half;  and  for  ourselves,  who  live  in  special  circle,  in  a  private 
hospital  where  only  the  insane  of  the  wealthier  classes  are  received,  we 
do  not  find  this  number  so  great.  For  ten  years  we  have  seen  general 
paralysis  becoming  more  frequent:  it  appears  sooner  in  the  life  of  man, 
and  if  one  considers  that  this  terrible  malady  attacks  without  mercy  the 
most  gifted,  one  cannot  help  feeling  profound  pity  for  the  poor  creatures 
Avho,  in  the  midst  of  their  insanitj^,  retain  the  most  delusive  ambition — 
who,  with  simple  credulity,  delight  in  the  most  deceptive  chimeras. 
The  dementia  {demence)  which  attacks  them  almost  unawares,  the  dimi- 
nution of  their  strength  together  with  that  of  their  intellect,  the  progres- 
sive deterioration,  which  may  be  traced,  step  by  step,  is  one  of  the  saddest 
and  most  heart-rending  pictures  which  can  be  imagined.  Nothing  stays 
its  victorious  march;  with  scarcely,  from  time  to  time,  a  few  periods  of 
abatement,  abruptly  broken  by  the  return  of  cerebral  congestion,  with 
epileptic  {epUeptiformes)  convulsions,  and  death,  after  eighteen  years  or 
two  months  of  a  purely  vegetative  existence,  coming  to  end  the  sad  trial 
— this  is  what  we  have  daily  before  our  eyes.  Paralytic  imbeciles  (les 
dements  paralytiques)  now  present,  in  the  admissions,  a  number  relatively 
large.  •  From  eighteen  hundred  and  forty-two  to  eighteen  hundred  and 
fifty -three  the  proportion  was:  for  males,  six  per  cent;  for  females,  three 
per  cent.  From  eighteen  hundred  and  fifty-six  to  eighteen  hundred  and 
sixty  the  number  increases  to  twelve  per  ceilt  for  males,  and  remains 
three  per  cent  for  females.  ^^  Cest  que  la  paralysie  generale  semble  recon- 
naitre  pour  cause  tout  ce  que  sur  excite  Vappareil  encephalo-rachidieu;"  in  its 
etiology  is  found  excess  of  all  kinds,  as  well  of  pleasure  as  of  labor,  and 
the  ambitious  delirium  which  is  one  of  its  commonest  characteristics  is 


.  80 

very  often  only  the  incessant  preoccupation  of  those  whom  it  attacks  in 
the  midst  of  tiieir  need  of  relaxation,  of  their  insatiable  desires.  It  is 
only  too  certain  that,  in  these  later  years,  general  paralysis  has  had  many 
more  victims;  what  we  have  ourselves  observed  is  confirmed  by  general 
statistics.  Among  epileptics  the  proportion  seems  to  have  diminished: 
we  do  not  well  explain  to  ourselves  from  what  influences;  we  state  this 
result.  From  eighteen  hundred  and  forty-two  to  eighteen  hundred  and 
fifty -three  it  was,  for  males,  eight  and  eight  tenths  per  cent;  among 
females,  six  and  four  tenths.  From  eighteen  hundred  and  fifty-six  to 
eighteen  hundred  and  sixty  it  is  only  four  and  thirty-one  hundredths 
among  males,  and  three  and.  seventeen  one  hundredths  among  females. 
Something  here  has  escaped  us,  and  we  are  inclined  to  think  that  in  pre- 
ceding statistics  the  number  of  epileptix3S  under  treatment  were  given; 
in  the  present,  that  of  the  epileptics  admitted  during  the  period,  which 
is  very  different.  In  both  cases  the  males  are  rej)resented  by  a  higher 
figure  than  the  females. 

Hitherto  we  have  considered  only  a  single  side  of  the  question.  It 
remains  for  us  to  see  what  becomes  of  the  insane  admitted  and  treated 
in  the  asylums — that  is  to  say,  to  study  the  discharges  before  or  after 
recovery,  and  the  deaths. 

The  proj^ortional  number  of  the  insane  discharged  before  or  after 
recovery  was  fourteen  and  forty-six  one  hundredths  per  cent  from 
eighteen  hundred  and  fifty-four  to  eighteen  hundred  and  sixty.  This 
number  is  a  little  less  than  that  of  the  period  eighteen  hundred  and 
forty-two  to  eighteen  hundred  and  fifty-three,  during  which  it  was  six- 
teen and  thirty-six  one  hundredths  per  cent.  But  that  which  was 
proved  at  that  epoch  i§,  also  found  to-day — more  males  are  discharged 
than  females.  Insanity  of  alcoholic  origin,  which  is  generally  cured 
quicklj',  being  more  common  among  males  than  among  females,  will  in 
part  explain  this  difference,  if  we  do  not  also  find,  to  the  disadvantage 
of  females,  all  chronic  diseases  of  the  utprus,  difficulties  succeeding 
delivery,  irregular  menstruation,  etc.  Depression  has  not  so  deep  or  so 
lasting  an  influence  among  males.  These  are  all  so  many  favorable  causes 
which  lead  to  a  more  certain  and  speedy  recovery.  Be  this  as  it  may, 
the  proportion  of  discharges  after  recovery  seems  to  have  diminished — 
that  of  discharges  before  recovery  to  have  increased  a  little.  We  do 
not  think,  for  our  part,  that  the  difference  can  be  very  great.  Many 
patients  leave  our  establishments,  public  or  private,  reclaimed  by  their 
friends  before  their  recovery  can  be  completed.  The  heads  of  the  office 
report  them  as  improved,  but  not  cured.  It  is  necessary,  in  order  that 
the  estimate  may  be  correct,  to  know  what  has  become  of  these  con- 
valescents, who  for  the  most  part,  attain  perfect  health.  These  docu- 
ments are  wanting;  all  correction  is  impossible,  and  the  numbers  have 
only  an  entirely  reLitive  value.  Thus  the  mean  of  discharges  after 
recovery,  from  eighteen  hundred  and  fifty-four  to  eighteen  hundred  and 
sixty,  was  only  seven  and  seventy-seven  one  hundredths  per  cent  of 
patients  treated;  of  discharges  before  recovery,  six  and  sixty-eight  one 
hundredths  per  cent.  Brierre  de  Boismont  had  good  reason  to  say,  in 
eighteen  hundred  and  fifty-nine,  that  it  should  not  be  estimated  thus. 
Too  many  elements  are  found  in  these  statistics,  and  cannot  be  officially 
separated  to  make  the  estimate  correct.  Who  does  not  see  at  once  that 
the  general  paralytics  included  in  the  total  number  of  insane  (for  exam- 
ple) fatally  condemned  to  incurability,  the  epileptics,  nearly  all  in  the 
same  condition,  make  of  themselves  alone  the  proportion  of  the  chronic 
insane  considerable;  the  proportion  -per  cent  of  cures  is  reduced  at  once 


81 

before  them,  and  to  attain  a  really  scientilic,  really  correct  data,  we 
should  take  the  acute  forms  presumed  to  be  curable,  and  then  see  the 
results  obtained.  If  we  should  adopt  this  course,  which  after  all  will  not 
lead  to  very  great  complications  in  the  formation  of  tables,  we  shall  not 
be  discouraged  by  the  disheartening  figure  of  seven  or  eight  per  cent  of 
cures.  This  is  the  weapon  of  which  the  opponents  of  the  law  of 
eighteen  hundred  and  thirty-eight  most  I'eadily  make  use. 

Indeed,  to  one  who  has  not  the  power  to  explain  it  there  is  something 
very  sad  in  these  official  statements.     We  are  not  reduced  to  a  situation 
as  discouraging  as  might  at  tirst   be  believed;  and  M.  Legoyt  himself 
comes  to  our  aid  by  saying  that  among  the  insane  treated  who  are  most 
certainly  cured  are  military  and  seafaring  men.     Why?     Because  they 
are  men  in  the  strength  of  youth,  who  are  generally  attacked  by  acute, 
curable  forms  of  mental  alienation ;  because  they  are  submitted  to  a  care- 
ful examination  at  the  commencement,  and  because  the  disease  is  treated 
almost  as  soon  as  it  appears.     General  paralysis,  which  w^e  justly  accuse 
of  increasing  the  number  of  our  failures,  does  not  yet  appear  among 
them.      It  is  from  thirty-live  to  forty-five  years  that  it  commits  the 
greatest  ravages.      Let  one  deduct  from  the  total  number  of  insane 
treated  the  epile]3tics,  the  paralytics,  the  idiots,  and  the  cretins;  let  him 
retain  the  acute  forms,  in  indicating  each  year  the  probable  prognostics 
of  those  remaining  under  treatment,  and  he  wall  see  that  the  recoveries 
are  not  so  rare  aslie  thinks.     As  to  the  discharges  before  recovery,  we 
do  not  attach  any  more  importance  to  them  than  they  deserve.     What 
are  they  generally?     Fruitless  trials  which,  after  short  duration,  result 
in  return  to  the  asylum.     They  are  escapes  followed  sooner  or  later  by 
reentry;  thej^  are  also  transfers  from  one  establishment  to  another,  of 
which  care  had  been  taken  to  keep  an  account.     A  more  correct  data, 
and  conformable,  moreover,  to  the  observations  collected  by  the  chefs  de 
service,  is  that  of  length  of  treatment  among  the  insane  cured.     Of  thir- 
teen thousand  six  hundred  and  eighty-seven  i]]sane  discharged  after 
recovery,  sixteen  hundred  and  sixty-three  were  discharged  after  a  resi- 
dence in  the  public  or  private  establishments  of  one  month  or  less.    The 
greater  number,  eighteen  hundred  and  eighty-seven,  were  discharged 
after  five  or  six  months  of  treatment;  fifteen  hundred  and  nineteen  after 
seven  or  eight  months;  seventeen  hundred  and  forty-eight  in  the  second 
month.     It  is,  then,  in  the  first  mouths  which  follow  the  attack  of  insan- 
ity that  the  cures  are  most  numerous;  let  us  add,  also,  that  they  are 
most  certain;  yet  it  might  have  been  important  to  describe  the  forms 
Avhich    are    most    quickly  relieved.      All   insanity  of   alcoholic   origin, 
especially  if  the  habit  of  drinking  is  not  inveterate  (if  there  has  not 
been  a  previous  attack),  is  decided  in  a  period  of  from  one  month  to  six 
weeks.     An  attack  of  mania  or  of  true  melancholy  {melancolle  frcmche) 
runs  its  course  in  five  or  six  months ;  a  few,  nevertheless,  have  lasted  a 
shorter  time.     Here  the  influence  of   cause  makes  itself  felt,  and  the 
influence  of  constitution;    and  if  one  could  determine  the  date  of  the 
appearance  of  the  derangement,  in  view  of  these  speedy  cures,  he  would 
see  that  the  insane  who  are  soonest  improved  are  those  who  have  been 
most  promptly  treated.     Moreover,  w^e  join  without  reserve  in  the  idea 
which  M.   Legoyt  has  thus  expressed:    "It   is  evident  that  it  is  the 
interest  of  families,  and  consequently  of  society,  that  the  insane  should 
be  placed  under  treatment  as  promptly  as  possible."     As  to  the  season 
of  the  year  at  which  the  recoveries  take  place,  the  following  has  been 
observed  of  one  thousand  recoveries: 
11 


82 


Months. 


Males. 


Females. 


December,  January,  February.. 

March,  April,  May 

June,  July,  August 

September,  October,  November 

Totals 


206 

195 

255 

248 

280 

283 

259 

274 

1,000 

1,000 

We  deem  it  proper,  also,  to  show  the  effects  of  the  seasons  on  mor- 
tality, and  for  this  purpose  insert  the  following  from  the  Thirteenth 
Scotch  Eeport: 

"  Cold  increases  the  mortality  among  all  classes  of  the  population,  and 
accordingly  the  deaths  in  asylums  are  most  numerous  in  the  colder 
months.  But  it  is  worthy  of  notice  that  while  the  mortality  of  both 
sexes  is  higher  in  Winter  than  in  Summer,  there  is  a  difference  in  the 
tendency  to  death  in  the  two  sexes  in  the  two  seasons. 

"  Of  every  one  hundred  deaths  which  took  place  in  asylums  in  the  six 
years  from  eighteen  hundred  and  sixty-five  to  eighteen  hundred  and 
seventy,  fifty-three  and  fifty-four  one  hundredths  took  place  in  Winter, 
and  forty-six  and  forty-five  one  hundredths  in  Summer.  The  number  of 
deaths  of  both  sexes  is  greatest  in  Winter,  but  the  tendency  to  death  is 
in  Summer  greater  among  females  than  males.  This  is  shown  by  the 
following  table: 

Table, 

Showing  the  Mortality  in  Summer  and  Winter  in  the  Asylums  of  Scotland 
for  six  years,  1865-1870. 


Summer. 
May  to  October. 

Winter. 
Xovember  to  April. 

Male  Mortality. 

Female  Mortality. 

Male  Mortality. 

Female  Mortality. 

620 

690 

789 

721 

As  to  age,  it  is  from  twenty-five  to  thirty-five  years  that  the  greatest 
success  is  obtained;  beyond  this  age  the  number  of  recoveries  gradually 
decreases,  as  the  activity  of  the  mental  faculties  also  diminishes.  The 
following  are  approximately  the  causes  among  about  one  half  of  the 
patients  recovered  of  whom,  alone,  any  positive  information  could  be 
obtained.  Drunkenness,  seventeen  hundred  and  thirty-eight;  domestic 
disappointments,  eleven  hundred  and  seventy-one;  various  diseases, 
seven  hundred  and  sixty-one;  diseases  peculiar  to  females,  seven  hun- 
dred and  twenty-three;  religious  excitement,  four  hundred  and  sixty. 
Hereditary  tendency  has  been  noted  among  fifteen  hundred  and  twenty- 
two  cured — about  fifteen  per  cent. 

The  mortality  appears  to  have  increased  slightly  in  the  asylums  in 


83 

the  period  included  between  eighteen  hundred  and  fifty-four  and  eigh- 
teen hundred  and  sixty.  In  the  preceding  years  it  was  thirteen  and 
seventy-five  one  hundredths  per  cent;  in  these  hist  seven  years  it  has 
been  fourteen  and  three  one  hundredths  per  cent.  It  is  unnecessary  to 
seek  for  reason  other  than  the  cholera  epidemic  of  eighteen  hundred 
and  fifty-four.  It  decreased  in  eighteen  hundred  and  fifty-nine  to  thir- 
teen and  eighteen  one  hundredths  per  cent,  and  in'  eighteen  hundred  and 
sixty  to  twelve  and  fifty-seven  one  hundredths.  Of  an  equal  number, 
one  hundred  and  thirty-one  males  die  to  one  hundred  females.  More 
than  twelve  per  cent  of  the  mortality  among  the  insane  took  place 
within  the  first  month  of  residence  in  the  asylum,  and  this  number,  rela- 
tively very  large,  has  given  rise  to  explanations  which  are  not  in  accord- 
ance with  facts.  It  is  said  that  "  the  cause  of  these  speedy  deaths  must 
be  the  arrest,  the  violent  agitation,  the  deep  disappointment  which 
patients  must  experience  on  being  abruptly  separated  from  their  fami- 
lies— confined,  without  knowing  the  reason,  in  this  violent  way."  This 
is  not  the  truth.  The  insane  who  die  so  quickly  bring  to  the  asylum 
the  diseases  under  which  they  sink.  We  have  means  to  prove  that  there 
is  only  a  very  small  number  who  have  a  semi-consciousness  of  change  of 
i^lace. 

Not  to  extend  the  limits  of  this  resume,  we  shall  present  the  figures 
for  three  years  only.  We  have  gathered  them  ourselves,  we  know  all 
the  particulars  of  the  disease,  and  we  can  prove  that  moral  disturbances 
have  counted  for  nothing  in  the  rapidity  of  the  fatal  termination.  What 
we  have  noticed  many  officers  have  also  observed,  and  Brierre  de  Bois- 
mont  has  devoted  himself  to  refute  an  opinion  wiiich  has  not  failed  to 
produce  a  sad  impression.  Figures  seem  to  err.  It  is  evident  that  more 
than  one  fourth  of  the  total  number  of  deaths  are  to  be  attributed  to 
the  first  three  months.  But  why?  It  is  because  frequently  there  are 
brought  to  the  as^dum  poor  patients  attacked  sometimes  with  cerebral 
tumors;  sometimes  with  organic  diseases  of  the  respiratory,  digestive,  or 
circulatory  organs;  sometimes  with  pneumonia  and  fevers;  sometimes 
with  alcoholic  intoxication  with  complication.  They  have  been  cared 
for  as  far  as  could  be  at  home.  They  have  only  been  sent  aw^ay  when 
frightful  hallucination,  continued  shrieks,  and  ungovernable  impulses 
have  made  it  dangerous  or  impossible.  A  few  days  more  and  they  would 
have  died  at  home.  They  are  brought;  the  journey  is  very  fatiguing  to 
them;  they  arrive  exhausted;  they  sink  in  the  midst  of  a  delirium 
which  has  not  even  allowed  them  time  to  perceive  that  they  have  been 
confided  to  the  hands  of  strangers.  The  asylum,  then,  should  not  be 
accused;  it  is  the  first  disease,  of  which  insanity  is  then  only  an  acci- 
dental manifestation. 

One  may  better  judge  from  the  following  table,  which  sums  up  our 
professional  observations. 

In  eighteen  hundred  and  sixty-four,  of  fifteen  deaths  (eleven  males, 
four  females),  six  died  in  less  than  a  year  after  their  admission: 


84 


Nature  of  the  Disease. 


Length  of  Residence. 


1.  70  jears 

2.  33  years 

3.  48  years 

4.  80  years 

5.  31  years 

6.  17  years 


Delirium  tremens,  third  attack;  epilep- 
tic (^pileptiformes)  convulsions 

Acute  delirium,  agitation,  and  constant 
shrieks  (cris);  nervous  exhaustion 

Consumptive;  cavernes  aux  deux  som- 
mets;  delire  de  persecutions ^ 

Sordid  avarice;  privations  of  all  kinds; 
allowing  himself  to  starve  in  a  garret. 
Interference  of  the  Commissioner  of 
Police.    Inanition 

Typhoid  fever,  with  hallucination  and 
delire  de  persecutions;  pneumonie 
h3'postatique  

Toung  woman  married  fifteen  days  pre- 
vious. Acute  delirium;  proved  her- 
editary   • • ■ 


Left  May  7th,  1863 
reentered  .lanuary 
died  the  13th;  four 

Three  weeks. 

Eight  days. 


Two  days. 
Twenty-nine  days. 
Fifteen  days. 


;  relapse; 
9th,  1864; 
days. 


In  eighteen  hundred  and  sixty-five,  of  eleven  deaths  (nine  males,  two 
females),  five  died  in  less  than  six  weeks  after  admission: 


1. 


2. 


45  years 
28  years 
34  3^ears 
36  years 

54  years 


Nature  of  the  Disease. 


Complete  dementia  (demence)  with  general  paralysis; 

cerebral  congestion;  epileptic  convulsions 

General  paralysis  a  marche  galopante;  m^ningo  enc6- 

phalite  suraigue 

Meningo  encephalite;  maniacal  delirium;  official  entry: 

nervous  exhaustion  produced  by  constant  agitation.... 
Dementia,  with  general  paralysis  progressing  rapidly; 

appearance  of   disease  six  months  before;  venereal 

excess;  increasing  debility  (atfaiblissement) 

Consumptive;  hallucination  and  delire  de  persecutions; 

agitation;  death  rather  sudden 


Length  of  Res. 


One  month. 
Six  weeks. 
Eight  days. 

Fourteen    (fays. 
One  month. 


In  eighteen  hundred  and  sixty-six  the  mortality  reached  a  very  high 
figure.  From  January  first  to  September  first  we  had  twelve  deaths — 
ten  males,  two  females.  Five  males  and  one  female  died  in  the  first 
month.  We  have  rarely  had  a  year  more  unfortunate  in  this  respect. 
It  will  be  seen  in  consequence  of  some  sad  circumstances,  all  accidental, 
moreover,  that  the  length  of  residence  has  been  so  short. 


85 


Nature  of  the  Disease. 


Length  Kesidence. 


1.  87  years 

2.  44  years 

3.  28  years 

4.  48  5'ears 

5.  26  years 

6.  39  years 


Appearance  ten  days  previous;  carried  to  the  City 
Hospital,  where  his  stay  was  impossible  from  his 
excitement  and  shrieks;  acute  delirium;  pulse  fili- 
forme 

General  paralysis;  complete  dementia;  convulsed 
condition 

Young  priest;  sick  for  a  month  at  the  seminary;  ex- 
citement and  shrieks  which  territied  his  colleagues 
and  prevented  their  keeping  him  longer;  six  hours 
travel  by  rail;  extreme  exhaustion;  pulse  at  one 
hundred  and  twelve;  typhoid  condition 

General  paralysis,  dating  three  years  back;  cared  for 
until  now  at  home,  but  for  some  time  creating  all 
sorts  of  difficulties;  intestinal  obstructions;  bal- 
lonnement  6norme  du  ventre;  asphyxie  par  com- 
pression   • 

Alcoholic  excess  having  caused  two  previous  attacks 
of  delirium  tremens;  sick  for  fifteen  days  in  a  hotel, 
where  he  continued  to  drink;  frightful  hallucina- 
tion, shrieks,  and  violence;  on  entering,  coldness 
of  the  extremities;   pas  de  pouls ._ 

Woman .  Dread ;  sleeplessness ;  d^lire  lypenianiaque ; 
refused  food;  then  acute  delirium;  maniacal  ex- 
citement  


Twenty-four  hours 
Six  weeks. 


Three  daj'^a. 


A  half  hour. 


Fifteen  hours. 


Fifteen  days. 


It  may  be  thought  that  we  have  dwelt  too  long  upon  this  point;  but 
it  seemed  to  us  iniportant  to  present  these  facts  with  some  details;  it  is 
not  possible  to  imagine  them  when  one  has  only  figures  before  his  eyes; 
but  to  every  impartial  mind  it  will  be  very  apparent  that  the  mental 
condition  of  those  persons  who  died  so  quickly  after  their  admission 
scarcely  allowed  them  to  appreciate  the  new  situation  provided  for  them 
by  entry  into  the  asylum.  Not  the  arrest,  then;  not  excited  feelings — 
nothing  but  serious  physical  conditions,  which  of  themselves  were  suf- 
ficient to  produce  death.  Thus  that  sort  of  accusation  which  charges 
the  asylum  with  a  mortality  whose  very  natural  explanation  need  not 
be  so  far-fetched,  falls  of  itself. 

There  still  remain  a  few  subjects  of  comment.  M.  Legoyt  completed 
his  work  by  researches  which,  properly  speaking,  only  the  administration 
promotes.  We  do  not  stop  there;  we  think  we  have  said  enough  to  set 
forth  the  qualities  which  characterize  his  work,  at  the  same  time  con- 
scientious, impartial,  and  moderate  in  its  estimates.  If  we  do  not  always 
agree  with  him,  it  is  because  we  look  from  a  difterent  point  of  view, 
placed  as  we  are  in  conditions  of  special  observation  which  allow  us  to 
go  to  the  root  of  things.  But  we  are  pleased  to  acknowledge  that  it 
was  impossible  to  have  done  better;  and  such  as  it  is,  the  statistics  from 
eighteen  hundred  and  fifty-four  to  eighteen  hundred  and  sixty  constitute 
one  of  the  most  interesting  documents  of  the  annals  of  mental  alienation. 

Does  this  important  work  which  we  wish  to  show  accuse  us  of  a  situ- 
ation as  fearful  as  has  been  represented?  We  do  not  think  so.  It  is 
impossible  to  deny  an  increase  in  the  number  of  admissions;  but  it  is 
just  also  to  acknowledge  that  if  the  special  causes  which  we  have  enu- 
merated have  favored  this  increase,  there  is  now  a  tendency  towards  an 
equilibrium,  which  we  hope  soon  to  see  definitely  established.  Our 
regretted  colleague,  Parchappe,  has  noticed,  with  all  the  authority  of  a 
long  experience,  a  few  of  these  questions,  in  a  discourse  delivered  last 


86 

year  before  the  Medical  Psychological  Society  at  Paris.*  We  will  not 
attempt,  after  him,  to  rehabilitate  our  asylums;  whoever  desires  to  be 
enlightened  will  ascertain  very  quickly  the  general  movement,  which, 
on  all  sides,  tends  towards  progress,  towards  perfection,  and,  conse- 
quently, towards  the  amelioration  of  the  lot  of  the  insane.  The  statistics 
themselves  prove  to  what  extent  everything  is  regularly  conducted, 
seriously  observed.  The  documents  of  which  it  is  constituted  were  not 
obtained  by  an  idle  or  ill-directed  administration.  There  is  in  the  supe- 
rior as  in  the  inferior  ranks  of  administrative  hierarchy  a  unity  of  aims 
and  tendencies  which  should  suffice  to  reassure  those  who  are  disturbed 
because  they  do  not  well  understand  the  subjects  upon  which  they  com- 
ment; for  ourselves,  who  are  witness  of  these  efforts,  who  heartily  unite 
in  them,  we  cannot,  without  regret,  see  our  intentions  undervalued;  we 
regret  that  we  are  judged  with  a  frivolity  which  we  should  not  have 
suspected  among  men  ^^^lose  habits  of  serious  investigation  should  have 
given  them  an  immunity  from  such  deviations.  We  think  that,  in  view 
of  this  formidable  scourge,  insanity,  it  w^ere  more  generous  to  assist  us, 
to  sustain  us  in  our  sad  task,  than  to  create  obstacles  and  to  discourage 
us  sometimes  by  unjust  suspicions.  Happily,  duty  accomplished  brings 
its  recompense  with  it;  and  if,  in  later  times,  we  have  been  the  object  of 
attacks  little  deserved,  this  justice  will  at  least  be  done  us,  that  we  have 
never  refused  to  reply,  not  ujDon  the  ground  of  delusive  theories,  but 
upon  that  of  facts.  It  has  seemed  expedient  for  our  cause  to  review  the 
work  of  a  man  as  enlightened  as  capable,  placed  by  his  official  situation 
in  that  quiet  region  penetrated  neither  by  the  spirit  of  party  nor  adven- 
turous ideas.  We  have  made  numerous  drafts  upon  M.  Legoyt,  and 
when,  in  some  matters  of  detail,  we  disagree  with  him,  it  is  because  we 
have  had  in  our  hands  documents  which  he  always  lacked.  The  statistics 
which  he  has  published,  more  complete  than  those  which  preceded,  are, 
in  our  idea,  a  work  of  rare  value.  They  are  one  of  the  best  arguments 
which  can  be  presented  to  those  who  try  to  believe  that  we  allow  our- 
selves to  be  soothed  by  that  easy  quiet  which  accepts  the  past  for  fear 
of  disturbing  the  future. 


CHAPTER  YIII. 
INSANITY  AMONG  THE  ANCIENTS. 

COMPARATIVE  VIEW  OF  THE  CONDITION  AND   TREATMENT  OF  THE  INSANE  AT  DIFFERENT 
PERIODS  AND  IN   DIFFERENT  COUNTRIES. 

In  the  time  of  the  Ancients — In  the  Middle  Ages— In  the  Eighteenth  and  Nineteenth 
Centuries — In  England — In  Erance— In  Kome— In  the  Germanic  Confederation — 
Observations  upon  Foregoing  Subjects — Cruel  Treatment  the  Kesult  of  Ignorance — 
New  York  Poor  Houses — Amelioration  in  the  Treatment  of  the  Insane  as  compared 
with  Former  Periods — Proof  of  the  Advantage  of  Moral  Treatment. 

The  ancients  regarded  insanity  as  the  result  of  some  supernatural 
power;  a  visitation  from  some  God,  at  whose  shrine  the  person  affected 
had  refused  to  worship,  or  as  a  punishment  for  irreverance  or  crime; 
but  the  psychologists  of  modern  times  have  endeavored  to  explain  its 
mysterious  eifects  on  scientific  principles.     Some  contend  that  the  mind 

*  Annals  MMico-Psychologiques,  1865,  p.  66. 


87 

alone  is  diseased;  others  that  it  is  a  disease  of  both  body  and  mind; 
while  the  great  majority  regard  it  as  "  a  disease  of  the  brain  affecting 
the  mind;"  and  while  the  latter  theory  accords  with  our  views,  and  is 
most  readily  understood,  w^e  propose  to  enter  into  no  argument  with 
those  who  have  lulvanced  and  still  maintain  a  different  view,  nor  is  it  a 
part  of  the  purpose  of  this  report  to  enter  into  any  metaphysical  discus- 
sion on  the  various  theories  that  have  been  advanced  in  this  or  any 
former  period  of  time. 

That  it  is  a  disease  in  some  shape,  all  will  admit.  That  it  is  extremely 
curable  when  properly  treated  in  its  earliest  stage,  none  will  deny.  That 
it  is  equally  intractable  and  unmanageable  after  it  has  fixed  itself  upon 
its  hapless  victim,  is  a  fact  that  those  best  acquainted  with  its  subtle 
nature  most  deplore.  It  seems  to  be  an  inevitable  if  not  a  natural 
attendant  upon  the  human  race.  It  has  been  present  among  men  from 
the  beginning,  or  from  the  earliest  records  to  the  present  day. 

The  feigned  madness  of  Ulysses,*  immediately  prior  to  the  Trojan 
war,  is  perhaps  the  earliest  reference  in  antiquity  to  the  existence  of 
mental  disease — otherwise  the  madness  of  Saul  claims  priority.  Ajax 
was  seized  with  madness  after  the  arms  of  Achilles  had  been  awarded 
to  his  rival  Ulysses.  Orestes  is  also  described  as  a  madman  by  his  sister 
Electra. 

The  "heaven  inspired  Cassandra"  was  regarded  by  the  Trojans  as 
insane.  Plato  alludes  to  the  connection  of  divination  and  insanity,  the 
prophetess  at  Delphi  and  the  priestess  at  Dodona  both  being  considered 
as  insane.  The  Sybil  and  others  being  classed  in  the  same  category, 
they  were  said  to  possess  the  mad  art. 

Several  other  allusions  are  made  to  madness  by  Plato  and  other  writ- 
ers of  antiquity.  Euripides  makes  many  allusions  to  madness,  and  the 
power  of  Bacchus  to  produce  it.  Lycurgus,  King  of  the  Edones  in 
Thrace,  refused  to  worship  Bacchus,  in  consequence  of  which  the  God 
visited  him  with  madness.  The  three  daughters  of  Praetus,  Lysippe, 
Iphinoe,  and  Iphianassa,  are  fabled  to  have  become  insane  in  consequence 
of  neglecting  the  worship  of  Bacchus.  They  ran  about  the  fields,  believ- 
ing themselves  to  be  cows.  Praetus  is  represented  to  have  applied  to 
Melampus  to  cure  his  daughters  of  insanity,  but  refused  to  employ  him 
when  he  demanded  a  third  part  of  his  kingdom  as  a  reward,  reminding 
us  of  the  enormous  sums  received  by  Willis  for  his  attendance  on  George 
III  and  the  Queen  of  Portugal.  This  neglect  of  Praetus  was  punished, 
and  madness  became  contagious  among  the  Argive  women.  The  persons 
affected,  however,  as  also  the  daughters  of  Praetus,  were  restored  on 
Melampus  being  feed  in  a  more  liberal  manner.  Athamas,  King  of 
Thebes,  and  Ino,  his  second  wife,  were  both  said  to  be  insane.  Medea, 
the  niece  of  Circe,  Cambyses,  Clomenes,  King  of  Sparta,  and  many  others 
might  be  mentioned.  Hippocrates  makes  many  allusions  in  his  writings 
to  mania,  melancholia,  and  epilepsy.  He  says  that  men  ought  to  know 
that  from  nothing  else  but  thence  (the  brain)  come  joys,  despondency, 
and  lamentations.  ,  By  the  same  organ  we  become  mad  and  delirious; 
and  fears  and  terrors  assail  us,  some  by  night  and  some  by  day. 

Diodes  (B.  C.  300)  and  Asclepiades  also  discuss  this  subject  in  their 
writings,  and  the  Eoman  poets  frequently  allude  to  it.  Persius  and 
Juvenal  both  speak  of  hellebore  as  a  remedy  for  madness. 

From  the  foregoing  extracts  we  learn  that  the  causes  of  insanity  were 

*  See  Bucknill  &  Tuke  on  Insanity. 


88 

supposed  to  be  very  different  in  the  olden  time  and  at  the  present  day. 
We  might  therefore  very  naturally  expect  a  different  mode  of  treatment 
corresponding  with  the  pathological  opinions  of  the  two  periods.  This, 
to  a  certain  extent,  is  true,  yet  it  will  he  interesting  to  the  non-profes- 
sional reader  to  learn  how  this  fearful  malady  was  treated  by  the  doc- 
tors of  that  day.  It  is  a  remarkable  fact,  as  we  learn  from  Bucknill  & 
Tuke,  that  some  of  them  at  least  were  as  earnestly  opposed  to  the  use 
of  mechanical  restraint  as  were  Pinel,  Charlesworth,  Hill,  or  Conolly, 
who  immortalized  their  names  in  the  seventeenth  century  by  advocating 
in  theory  and  carrying  out  in  practice  the  non-restraint  system  that  has 
done  so  much  to  ameliorate  the  condition  of  the  insane  in  the  asylums 
of  the  2^1'esent  day  in  most  of  the  enlightened  countries  of  the  world. 
Bleeding,  so  much  in  vogue  at  a  later  day,  was  also  condemned  by  one 
at  least  of  these  celebrated  men,  as  we  will  see  by  the  following: 

OPINIONS  OF    ANCIENT  MEDICAL  WRITERS  ON  THE  TREATMENT  OF  THE  INSANE.  * 

Music  is  the  first  recorded  remedy  employed,  so  far  as  we  are  aw^are, 
for  the  relief  of  madness.  That  ancient  musician  of  whom  it  has  been 
said  that  he  struck  tones  that  were  an  echo  of  the  sphere  harmonies, 
"took  an  harp  and  played  with  his  hand;  so  Saul  was  refreshed  and  w^as 
well,  and  the  evil  spirit  departed  from  him."  Music  ajDpears  to  have 
been  strongly  recommended  by  Asclepiades. 

Asclepiades  was  certainly  one  of  the  most  definite  in  his  directions  in 
regard  to  the  treatment  of  the  insane.  As  we  have  already  said,  he  pre- 
scribed music.  He  especially  recommended  that  the  patient  should 
abstain  from  food,  drink,  and  sleep,  in  the  early  part  of  the  day;  that  in 
the  evening  he  should  drink  water,  that  then  gentle  friction  should  be 
applied,  while  later  still,  liquid  food  should  be  given,  with  a  repetition 
of  the  frictions.  By  these  means  sleep  was  supposed  to  be  induced.  He 
regarded  as  Avorse  than  useless  the  application  of  narcotic  fomentations, 
referring  specially  to  hyoscyamus,  mandragora,  and  poppies.  Such 
reference  to  these  remedies  is  interesting,  as  showing  their  use  prior  to 
the  time  in  which  he  flourished.  He  directed  that  the  patient  should  be 
placed  in  the  light.  To  employ  bleeding,  was,  he  thought,  little  short 
of  madness.  According  to  Csclius  Aurelianus,  Asclepiades  ordered  his 
patients  to  be  chained.  Feuchtetsleben  in  his  Medical  Psychology, 
states  that  Asclepiades  recommends  "that  bodily  restraint  should  be 
avoided  as  much  as  possible,  and  that  none  but  the  most  dangerous 
should  be  confined  by  bonds;  "  referring  to  Celsus  and  Cadius  Aurelianus 
as  his  authorities  for  the  opinions  of  Asclepiades,  whose  works  are  lost; 
but  neither  of  these  writers  appears  to  assert  so  much.  Themison, 
another  disciple  of  Asclepiades,  and  who  is  often  regarded  as  the  real 
founder  of  the  School  of  the  Methodici,  styled  "  phlebotomotos  "  by 
Cselius,  followed,  to  a  considerable  extent,  in  the  steps  of  his  predeces- 
sor as  regards  treatment;  but  prescribed  the  bath  and  more  liberal 
regimen,  and    ordered   astringent   fomentations  (constrictira  fomenta). 

The  treatment  recommended  by  the  celebrated  Celsus,  in  his  chapter 
entitled,  JDe  tribas  insanice  generibus,  may  next  be  considered.  On  the 
whole,  the  directions  of  this  physician  are  harsh,  and  scarcely  merit  the 
praise  which  some  authors  have  bestowed  upon  them.  It  is  true,  that 
he  admits,  in  regard  to  those  who  ramble  in  their  discourses  or  attempt 


Bucknill  &  Tuke  on  Insanity. 


89 

some  trifling  injury  with  their  hands,  that  it  is  unnecessary  to  employ 
any  rough,  coercive  measures.     He  deemed  it  proper,  however,  to  subdue 
those  who  were   more  violent  by  a  very  compulsory  treatment,  "  lest 
they  should   injure   themselves   or   others."     Their    audacity  must   be 
coerced,  and  they  must  be  brought  to  submission  by  blows,  as  in  the 
case  of  any  one  else  who  requires  restraint.     Excessive  mirth  must  be 
checked  by  scolding.     If  conciliatory  measures   fail,  patients   must   be 
cured  by  some  kind  of  torment;  thus,  should  they  be  detected  in  false- 
hood or  deceit,  they  must  be  hungered,  or  bound  in  chains,  or  flogged. 
By  these  means,  he  assures  us,  they  will  before  long,  through  the  influ- 
ence of  fear,  be  thoroughly  disposed  to  come  to  terms,  to  eat  anything; 
and  even  their  memory,  he  says,  will  thus  be  refreshed.     For  to  startle 
them  suddenly,  and  greatly  to  terrify  them,  is  profitable  in  this  disease; 
anything,  in  short,  by  which  the  mind  is  violently  disturbed.     To  close 
up  all  the  avenues  of  pity  this  humane  physician  also  says  that  you  are 
not  to  believe  anyone  who  thus  subdued,  while  he  is  desirous  of  being 
released   from  his  bonds,  pretends  that  he  is  sane,  however  prudently 
and  piteously  he  may  converse,  since  this  very  deceit  is  the  result  of 
madness.     On  which  enlightened  principle  it  is  difiicult  to  understand 
how  Celsus  himself  wouldhave  escaped  had  he  once  been  so  unfortunate 
as  to  be  suspected  of  insanity.     Celsus  by  no   means,  however,  over- 
looked all  medical  treatment.  "He  approved  of  venesection,  and  of  cup- 
ping  applied  to  the  head,  which,  he  observes,  will  have  the  effect  of 
inducing  sleep.    Should  any  symptom  render  bleeding  unsuitable,  the  next 
best   remedy  is   abstinence,  followed   by  an   emetic  and  a  purgative  of 
white  hellebore,  and  if  possible  the  employment  of  friction  twice  in  the 
day.     He  is  here  speaking  of  those  cases  in  which  sadness  appears  to  be 
the  result  of  black  bile.     jSTo  longer  under  the  influence  of  apprehension 
from  the  violence  of  the  patient,  Celsus    directs   that  fear    should    be 
removed  from  his  mind,  and  cheerful  hopes  excited;    pleasure  being- 
sought  in  fables  and  sports,  and  whatever  else  may  be  conducive   to 
health.     Patients  are  to  be  judiciously  encouraged  in  their  several  occu- 
pations, and  their  groundless  fears  are  to  be  lightly  reproved.     Cold 
water  is  also  to  be  poured  upon  the  head  of  the  patient,  and  his  body 
immersed  in  water  and  oil.     In  maniacal  cases,  warm  fomentations  might 
be  applied  to  the  shaven  head;  when,  in  consequence,  the  febrile  symp- 
toms abate,  we  are  to  have  recourse  to  friction;  but  we  must  use  it  more 
sparingly  in  those  cases  in  which  the  patients  are  exhilerated  than  in 
those  in  which  they  are  depressed.     In  the  maniacal  paroxysm  itself, 
however,  Celsus  had  not  much  faith  in  medical  applications;  indeed,  he 
was  afraid  that  by  such  means  the  fever  would  be  increased.     There- 
fore in  such  cases,  says  he,  do  nothing  with  the  patient  but  confine  him. 

Severe  as  was  Celsus  upon  the  insane  who  were  guilty  of  deception, 
he  had  no  hesitation  in  employing  similar  means  towards  the  patient, 
AYe  need  not  quarrel  with  the  direction,  that  should  the  patient  refuse 
to  swallow  the  doctor's  favorite  hellebore  mixture  he  is  to  be  deceived  by 
having  it  mixed  in  his  food;  but  we  may  well  dissent  from  the  pro- 
priety of  another  direction,  namely:  that  should  it  be  necessary  to 
inspire  fear,  and  should  the  patient  be  a  rich  man,  you  are  to  announce 
to  him  the  false  intelligence  of  a  lost  estate. 

The  good  effect  of  a  full  diet  in  some  cases  of  insomnia  was  very 
properly  pointed  out.  Other  somniferous  remedies  prescribed  by  Celsus 
were  friction,  exercise  after  food,  and  by  night  the  sound  of  a  waterfall, 

12 


90 

but  chiefly  the  rocking  motion  of  a  suspended  bed.  Kor  were  the  sooth- 
ing influences  of  music  in  melancholy  overlooked.  The  mind  was  also 
to  be  called  forth  in  some  cases  b}^  reading  aloud,  and  occasionally  errors 
might  be  made  in  order  to  elicit  the  critical  powers  of  the  patient. 
Cselius  regarded  it  as  essentially  necessary  to  i^lace  the  maniacal  in  a 
room  •  moderately  light  and  warm,  and  to  avoid  everything  of  an  excit- 
ing character.  Pictures  were  not  to  be  allowed,  nor  was  the  window  to 
be  too  high,  nor  was  the  room  to  be  in  the  u^Dper  story,  the  reason  being 
added  that  many  when  seized  with  madness  have  thrown  themselves 
out.  The  bed  was  to  be  firm,  and  so  placed  that  the  patient  could  not 
be  disturbed  by  the  sight  of  persons  entering  the  room;  it  was  to  be  of 
straw,  soft,  and  well  beaten,  but  not  broken.  If  the  j^atient  was  in  dan- 
ger of  injuring  himself,  soft  wool  moistened  was  aj^plied  to  the  head, 
neck,  and  chest;  thus  instead  of  having  a  padded  room  Cselius  padded 
his  j^atient.  The  duty  of  attendants,  in  regard  to  deception,  is  clearly 
laid  down.  They  were  to  beware  on  the  one  hand  of  seeming  to  con- 
firm the  patient's  delusions,  and  thus  increase  his  disorder,  and  on  the 
other  they  were  to  be  careful  not  to  exasperate  him  by  too  much  oppo- 
sition, but  at  one  time  by  indulgent  condescension,  at  another  by  insinu- 
ation, endeavor  to  correct  his  delusion.  Should  the  patient  attempt  to 
escape  and  be  with  difficulty  restrained  or  exasperated  with  seclusion, 
then,  says  Cselius,  with  admirable  perception,  3-ou  must  employ  more 
attendants.  Let  these,  he  adds,  without  the  patient  perceiving  the  real 
object  in  view,  engage  themselves  in  applying  friction  to  his  limbs. 
Further:  should  this  treatment  fail,  and  the  violence  be  great,  a  ligature 
may  be  resorted  to,  being  quietly  applied,  and  the  limbs  protected  by 
wool.  Should  the  patient  have  been  accustomed  to  submission  and  rev- 
erence, this,  he  observes,  will  not  require  frequent  repetition — for  such 
repetition  would  induce  contempt,  and  when  patients  do  not  yield  to 
such  a  course  of  treatment,  then  it  becomes  necessary  to  subdue  them 
by  inducing  fear  or  awe.  Should  the  patient's  eyes  be  affected  by  the 
light,  they  must,  according  to  our  author,  be  shaded;  but,  he  adds,  with 
great  discrimination,  in  such  a  way  that  other  parts  of  the  body  may 
not  be  deprived  of  light.  Cselius  directed  that  abstinence  from  food 
might  be  carried  so  far  as  to  induce  slight  hunger,  adding  that  the 
strength  may  be  reduced  by  bleeding,  if  the  malady  require  it,  even 
during  such  abstinence  should  there  be  nothing  present  to  contra  indi- 
cate it.  The  food  was  to  be  light  and  digestible,  as  bread  softened  in 
warm  water,  or  a  preparation  of  wheat  lightly  boiled  with  honey,  etc. 
Alternate  days  of  fasting  and  feeding  were  likewise  recommended. 
Benefit  also  might  be  derived  from  clysters,  and  the  application  of  an 
emollient  cataplasm  to  the  region  of  the  heart. 

Should  the  disorder  become  stationary,  Calius  advises  the  head  to  be 
shaved,  and  cupping  to  be  applied,  first  over  the  chest,  then  between  the 
shoulders  ('•  for  these  parts  sympathize  with  the  head  "),  and  next  to 
the  head.  A  restless  and  sleepless  condition  was  to  be  relieved  by 
carrying  the  patient  about  on  a  litter  or  in  a  chair.  To  this  was  to  be 
added  the  monotonous  sound  of  running  water.  Fomentations,  by 
means  of  warm  sponges,  were  to  be  aj^plied  over  the  eyelids,  with  the 
idea  of  relaxing  them,  and  in  the  hoj^e  of  exerting  a  curative  influence 
over  the  meninges  of  the  brain.  As  reason  returned,  moderate  exercise 
was  strongly  recommended — riding,  walking,  and  exertion  of  the  voice. 
The  patient  was  to  read  compositions  containing  inaccuracies,  in  order 
the  better  to  exercise  the  understanding;  but  Caslius  adds  a  caution  that 
this  must  not  be  too  difficult,  lest  the  patient  be  overdone  with  laborious 


91 

mental  exercise,  which  were  as  detrimental  to  the  mind  as  immod- 
erate exertion  to  the  body.  Theatrical  entertainments  were  to  follow 
for  those  laboring  under  melanchQly,  and  scenes  of  a  solemn  or  tragic 
character  were  to^coiinteract  excessive  hilarity  and  excitement. 

Subjects  of  disputation  might  be  added  as  the  patient  recovered,  con- 
ducted in  a  low  tone  of  voice,  the  preference  being  given  to  narrative 
and  demonstrative  subjects.  Further,  individuals  known  to  the  patients 
were  to  be  employed  to  converse  with  them,  in  a  manner  calculated  to 
encourage  and  aiiiuse  them.  These  various  mental  exercises  were  to  be 
followed  by  rubbing  Avith  oil,  and  a  gentle  walk.  Here,  our  author 
suddenly  remembers" that  much  of  the  preceding  treatment  could  not  be 
carried 'out  with  the  illiterate;  for  such,  he  prescribes  questions  having 
reference  to  their  particular  callings;  as,  on  farming,  for  the  agricul- 
turist; navigation,  for  the  sailor;  and  for  those  ignorant  even  of  these, 
questions  of  a  general  nature  must  be  propounded.  Shampooing,  as 
well  as  inunction,  was  an  important  remedy  with  Calius,  including 
frictions  of  the  head.  The  diet  was  to  be  improved  as  the  patient's 
health  returned,  wine  being  forbidden  in  the  lirst  instance,  gradually 
allowed  after  the  use  of  fruit,  but  then  only  of  light  quality. 

As  the  mind  recovered  its  tone,  the  patient  was  allowed  to  go  and 
hear  the  disputations  of  the  i^hilosophers,  from  the  persuasion  that  the 
passions  of  grief,  fear,  and  anger  were  thus  dissipated.  If,  on  the  con- 
trary, the  patient  relapsed,  the  former  treatment  was  to  be  resumed, 
adding  exposure  of  the  body  to  the  heat  of  the  sun,  the  head  being 
covered.  The  administration  of  an  emetic  made  from  the  root  of  white 
hellebore,  was  to  be  added,  to  which,  if  the  patient  objected,  vomiting 
was  to  be  promoted  by  tickling  the  fauces.  The  ears  were  to  be  injected 
with  water  containing  a  little  nitre,  honey,  nettle  seed,  or  mustard;  the 
rationale  given  being,  that  even  through  the  channels  of  the  senses, 
a  resta»-ative  virtue  may  be  conveyed  to  the  membranes  of  the  brain, 
especially  as  patients  are  often  affected  with  tinnitus  aurium.  Finally, 
the  cure  of  the  patient  was  to  be  established  by  travelling  and  sea 
voyages. 

After  thus  stating  the  mode  of  treatment  which  recommended  itself 
to  his  judgment,  C^lius  proceeds  to  condemn  the  practice  of  some  who 
had  preceded  him.  Some  of  the  Methodici,  he  observes,  have  recom- 
mended close  confinement  in  a  dark  room,  forgetting  that  the  patient's 
dislike  to  it  may  aggravate  his  disorder,  and  that  too  much  seclusion 
from  the  air  causes  dense  bodies  to  perspire,  and  that  the  omission  of 
ordinary  occupations  will  aggravate  cerebral  congestion.  He  then 
denounces  the  extreme  abstinence  which  was  recommended,  in  forgetful- 
ness  of  the  fact  that  such  a  course  disorders  the  bodily  powers  and  is 
one  which  the  patient  will  be  unable  to  bear.  The  supporters  of  such 
regimen  referred  to  the  taming  of  wild  beasts  as  analogous  and  as  a 
proof  that  madness  may  be  thus  repressed;  but  Ceelius,  anticipating  the 
practice  of  the  present  day,  states  that  they  should  have  known  better 
from  a  consideration  of  the  effect  of  hunger  upon  the  sane  in  inducing 
rage.  He  does  not  hesitate  to  assert  that  the  starving  system  will 
induce  madness  rather  than  cure  it.  He  then  refers  to  a  subject  of 
especial  interest  to  us  in  our  time,  and  his  observations  are  calculated  to 
humiliate  us,  exhibiting,  as  they  do,  a  far  seeing  philanthrophy  which 
those  who  have  treated  the  insane  have,  until  very  lately,  failed  to  imi- 
tate. Cselius  observes  that  they  also  order  the  patients  to  be  bound 
with  chains,  without  any  consideration  that  the  bound  parts  must  neces- 
sarily be  chafed,  and  how  much  more  properly  the  patients  might  be 


92 

restrained  by  the  care  of  attendants  than  by  senseless  chains.  He  is 
alike  indignant  against  those  who  would  coerce  by  flagellation,  especially 
about  the  face  and  head,  which,  so  far  from  relieving  the  disease,  only 
induces  swellings  and  sores;  in  addition  to  which,  the  returning  con- 
sciousness of  the  patient  could  not  but  be  hurt  by  the  sense  of  his 
wounds. 

In  regard  to  the  relative  advantages  of  cold  and  warm  applications, 
Cselius  sjoeaks  of  those  who  endeavor  to  induce  sleep  by  warm  fomen- 
tations of  poppy,  thyme,  roses,  etc.,  and  observes,  in  accordance  with 
the  view  attributed  by  Calius  to  Asclepiades,  that  the  result  is  heavi- 
ness of  the  head,  but  not  sleep — constriction  being  induced,  when  relaxa- 
tion is  required.  He  then  refers  to  an  ojDposite  school  who  made  use  of 
cold  applications,  believing  the  disorder  to  be  caused  by  heat;  ignorant, 
he  observes,  that  internal  heat  is  an  undoubted  sign  of  congestion,  and 
not,  as  they  think,  the  cause  of  the  disease.  He  condemns  the  hydro- 
pathic treatment  as  being  calculated  to  increase  congestion,  and  there- 
fore to  aggravate  the  patient's  disorder.  In  regard  to  the  important 
question  of  venesection  in  mania,  Ceelius  comments  upon  the  practice  of 
those  who  employed  excessive  bleeding  from  both  arms  to  the  extent  of 
syncope  and  even  death,  and  observes  that  the  abstraction  of  blood  from 
both  arms  is  not  to  be  j)racticed  in  consequence  of  the  fearful  prostra- 
tion of  strength  which  may  follow.  Clysters  he  regarded  as  worse  than 
useless,  often  inducing  dysentery  in  consequence  of  the  active  ingre- 
dients which  they  contained.  Among  the  many  strange  and  opposite 
modes  of  treatment  to  which  the  insane  have  been  subjected,  intoxica- 
tion was  not  overlooked.  Some,  our  author  observes,  recommend  intoxi- 
cation, since  madness  is  often  caused  by  it;  but  without  sufficient  dis- 
crimination, since  injudiciously  used  it  may  prove  injurious.  The  plea- 
sures of  love,  which  were  prescribed  b}^  Titus  and  Themison,  were 
strongly  condemned  by  Caelius,  who  regards  as  impious  and  ab^rd  the 
attempt  to  indulge  propensities  which  required  restraint. 

In  the  chapter  which  treats  of  melancholy,  Cselius  observes  that  the 
treatment  is  the  same  as  has  been  already  prescribed  for  the  maniacal. 
He  would  not  bleed,  nor  depress  the  patient  by  purging  him  with  helle- 
bore and  aloes,  but  at  once  soothe  and  invigorate  him  by  emollient  and 
astringent  applications.  The  celebrated  Galen,  of  Pergamos,  flourished 
at  a  period  but  little  subsequent  to  C^lius  Aurelianus.  He  is  said  to 
have  died  at  the  age  of  ninety,  A.  D.  one  hundred  and'  ninety-three. 
His  treatment  was  based  upon  the  humoral  pathology,  which  was  in 
such  high  repute  among  the  ancients,  and  which  exercised  an  almost 
universal  influence  on  their  practice.  He  lays  it  down  that,  if  moisture 
produces  fatuity  and  dryness  sagacity,  just  in  proportion  to  the  excess 
of  moisture  over  dryness  the  sagacity  will  be  diminished.  Hence,  he 
advises  the  practitioner  to  aim  above  all  things  at  preserving  a  just  me- 
dium between  these  opposite  qualities.  He  recommends  that  "  should 
you  be  of  opinion  that  the  whole  of  the  patient's  body  may  contain  mel- 
ancholy blood  "  you  are  to  employ  venesection,  especially  from  the  median 
cephalic  vein.  He  adds,  that  should  the  blood  flowing  from  it  not  appear 
to  be  of  a  melancholy  quality,  the  vein  must  immediately  be  closed;  and 
that  should  the  contrary  be  the  case,  you  are  to  abstract  as  much  blood 
as  the  state  of  the  patient  and  his  habit  of  body  shall  permit.  If,  how- 
ever, madness  arise  from  idiopathic  disease  of  the  brain,  bleeding  is  by 
all  means  to  be  avoided.  In  forming  an  opinion  on  this  subject,  regard 
was  to  be  had  to  the  patient's  constitution  and  temperament.  The  fat, 
the  fair,  and  the  flabby  were  not  to  be  supposed  to  possess  any  melan- 


9S 

choly  humor;  but  the  lean,  dark,  and  hairy,  and  those  in  whom  the  veins 
are  large,  are  the  most  subject  to  its  accumulation.  He  gives  a  long 
enumeration  of  the  kinds  of  food  which  induce  melancholy,  as  the  flesh 
of  oxen,  goats,  but  especially  asses  and  camels,  and  also  wolves,  dogs, 
hares,  and  snails.  Among  herbs,  the  cabbage  only  is  mentioned.  Thick 
and  black  wine  was  to  be  particularly  avoided,  "  as  from  it  the  melan- 
choly humor  is  made."  This  melancholy  humor  is  spoken  of  by  Galen 
as  a  condition  of  blood  "thickened,  and  more  like  black  bile  which,  in- 
deed, exhaling  to  the  brain,  causes  melancholy  symptoms  to  affect  the 
mind."  We  frequently  also  notice,  he  observes,  that  when  yellow  bile 
is  contained  in  the  stomach,  the  head  is  painfully  aifected;  but  it  imme- 
diately recovers  when  the  stomach  is  relieved  from  bile  by  vomiting.  In 
mild  cases  of  insanity  Galen  prescribed  the  bath  and  nourishing  food. 

IN   TQE    MIDDLE   AGES. 

We  have  thus  taken  a  hurried  glance  at  the  opinions  of  the  ancients 
with  regard  to  the  pathology  of  this  mysterious  disease,  and  of  the 
treatment  employed  by  them  for  its  cure  or  amelioration,  and  it  is 
strange,  indeed,  that  we  hear  but  little  more  of  it  until  about  the  period 
of  the  reformation.  It  is  true  that  an  asylum  is  said  to  have  existed  at 
Jerusalem  about  the  fifth  century,  but  little  seems  to  be  known  of  its 
character,  history,  or  the  modes  of  treatment  employed.  Again,  at  a 
period  assigned  by  tradition,  about  eleven  centuries  ago,  the  tragic  death 
of  the  Irish  girl,  the  Princess  Dymphna,  who  was  slain  by  the  hand  of 
her  own  father,  led  to  the  establishment  of  a  church  and  altar  at  Gheel, 
in  Belgium,  where  those  afflicted  with  "  minds  diseased  "  were  carried  to 
intercede  with  the  spirit  of  the  patron  saint  for  relief;  and  a  number  of 
these  unfortunate  victims,  more  or  less  numerous,  are  supposed  to  have 
been  kept  there  ever  since;  till  now  it  has  grown  into  one  of  the  most 
remarkable  institutions  for  the  insane  that  anywhere  exists. 

The  next  asylum  established,  so  far  as  we  are  able  to  ascertain,  was 
that  of  "Eeinier  Van  Arkel,"  at  Bois  le  Due,  in  Holland.  It  bears  the 
name  of  its  philanthropic  founder,  who  established  it  in  fourteen  hun- 
dred and  forty-two,  for  the  care  and  custody  of  six  unfortunate  persons 
who  had  been  deprived  of  their  reason.  From  this  small  beginning,  it 
has  continued  to  increase,  till  it  now  has  capacity  for  six  hundred 
patients;  but  on  the  first  of  December,  eighteen  hundred  and  seventy, 
three  hundred  of  its  inmates  were  removed  to  a  new  asylum,  just 
finished,  a  short  distance  from  the  city.  At  the  time  of  our  visit — 
seventh  of  July,  eighteen  hundred  and  seventy-one — there  were  one  hun- 
dred and  seventy  men  and  one  hundred  and  fifty-six  women  within  its 
walls.  The  old  asylum  is  immediately  on  one  of  the  business  streets  of 
the  city,  and  has  been  so  often  added  to  and  enlarged  that  it  can  be  said 
to  possess  no  particular  plan.  It  still  retains  many  evidences  of  the  age 
in  which  it  was  built,  and  shows  more  clearly  than  anything  we  have 
elsewhere  seen,  the  wonderful  and  beneficent  improvements  that  have 
been  made  in  the  character  of  the  buildings  for  the  treatment  of  the 
insane.  Small  dark  cells,  with  high  small  windows,  and  cribs  in  which 
to  cage  the  excited  patients,  may  still  be  seen,  and  we  regret  to  say  have 
not  yet  been  entirely  abolished  in  this  and  one  or  two  other  asylums 
visited  on  the  continent.  The  douche,  solitary  confinement,  and  confine- 
ment to  the  chair,  are  also  used  in  some  cases,  not  as  a  part  of  the  treat- 
ment, but  for  punishment — showing  how  difficult  it  is  even  yet,  in  some 
countries,  to  shake  off  old  habits  and  adopt  new  ideas  in  the  treatment 


H 

of  the  insane.  The  inquiring  mind  of  the  young  and  intelligent  physi- 
cian, Dr.  Frijbank,  will  doubtless  soon  lead  him  to  discard  all  of  these 
old  appliances,  and  to  adopt  the  more  humane  and  enlightened  practice 
of  the  age  in  which  he  lives.  Indeed,  it  is  but  just  to  say  that  he  has 
already  done  so  in  most  respects. 

As  another  link  in  the  history  and  treatment  of  this  malad}^,  the  fol- 
lowing extracts  will  show  the  condition  of  the  insane  in  asylums  in  the 
eighteenth  and  nineteenth  centuries: 

IN    ENGLAND. 

''  The  reader  of  Caelius  Aurelianus  cannot  but  feel  astonished  when  he 
'finds  that  nearly  eighteen  hundred  years  after  that  humane  physician 
flourished  it  could  be  said  in  the  House  of  Commons,  by  the  Earl  of 
Shaftesbury  (then  Lord  Ashley),  that  the  whole  history  of  the  world, 
until  the  era  of  the  Eeformation,  does  not  afford  an  instance  of  a  single 
receptacle  assigned  to  the  protection  and  care  of  these  unhappy  suffer- 
ers, whose  malady  was  looked  upon  as  hardly  within  the  reach  or  hope 
of  medical  aid.  If  dangerous,  they  were  incarcerated  in  the  common 
prisons;  if  of  a  certain  rank  in  society,  they  were  shut  up  in  their 
houses,  under  the  care  of  appropriate  guardians.  Chains,  whips,  dark- 
ness, and  solitude  were  the  approved  and  only  remedies. 

"  It  is,  indeed,  to  be  feared  that  the  directions  of  Celsus  have  exercised 
a  most  prejudicial  influence,  even  till  within  a  very  recent  period;  and  it 
is  not  difficult  to  recognize  them  in  the  w^ritings  of  the  classical  Cullen, 
who  did  not  omit  to  recommend  the  employment  of  'stripes'  in  the 
treatment  of  the  maniacal. 

"  The  kind  of  treatment  pursued  by  the  highest  medical  men  four  hun- 
dred years  ago  is  pretty  clearly  indicated  by  what  has  been  handed 
down  to  us  relative  to  the  psychological  history  of  King  Henry  YI,  in 
whom  mental  disease  was  hereditary.  Thus  we  are  informed  that  five 
physicians  and  surgeons  were  appointed  to  attend  the  royal  patient,  and 
were  empowered  to  administer  'electuaries,  potions,  and  syrups,  confec-' 
tions  and  laxative  medicines,  in  any  form  that  might  be  thought  best; 
baths,  fomentations,  embrocations,  unctions,  plasters,  shavings  of  the 
head,  and  scarifications.' 

"  It  is  not  a  little  singular  that  Bethlem  Hospital,  which  has  become  on 
various  occasions  so  notorious  for  its  ill  treatment  of  the  insane,  should  in 
the  first  instance  have  provided  for  their  care  Vv-ith  benevolent  intentions, 
and  under  some  favorable  auspices.  It  was  in  the  year  fifteen  hundred 
and  forty-seven  that  Henry  YIII  took  possession  of  the  monastery  or 
hospital  of  St.  Mary  of  Bethlem,  and  presented  it  to  the  City  of  London, 
with  an  order  that  it  should  be  converted  into  a  house  for  the  .reception 
of  lunatics.  It  w^as  situated  in  Bishopsgate  AYard,  without  the  city  wall, 
between  Bishopsgate  street  and  Moorfields.  Stow  describes  it  in  his 
time  as  standing  in  an  obscure  and  close  place  in  the  neighborhood  of 
many  common  scAvers,  and  as  also  too  small  to  receive  and  entertain  the 
great  number  of  distracted  persons,  both  men  and  woinen,  who  stood  in 
need  of  it." 

In  consequence  of  the  want  of  further  provision  for  lunatics  in  London, 
a  large  building  was  erected  in  sixteen  hundred  and  sevent^^-five  in 
Moorfields,  where  the  hospital  stood  until  eighteen  hundred  and  fourteen. 
There  was,  in  a  short  time,  accommodation  for  one  hundred  and  fifty 
patients;  whereas,  in  the  old  building,  there  were  usually  but  fifty  or 
sixty.     In  the  rules  made  March  thirtieth,  sixteen  hundred  and  seventy- 


95 

seven,  to  which  it  is  interesting  to  refer,  it  is  ordered  inter  alia,  that  such 
of  the  lunatics  as  are  fit  should  be  permitted  to  walk  in  the  yard  until 
dinner  time,  and  then  be  locked  up  in  their  cells;  and  that  no  lunatic 
that  lies  naked,  or  is  in  a  course  of  physic,  should  be  seen  by  anybody 
without  an  order  of  the  physician.  It  is  further  humanely  ordered  that 
no  officer  or  servant  shall  beat  or  abuse  any  lunatic,  or  employ  any  force 
to  them,  but  upon  absolute  necessity  for  the  better  governing  of  them. 
Dr.  Tyson,  who  was  physician  to  Bethlem  from  sixteen  hundred  and 
eighty-four  to  seventeen  hundred  and  three,  informs  us  that,  as  to  the 
care  and  cure  of  the  patients,  here  is  undoubtedly  the  greatest  provision 
made  for  them  of  any  public  charity  in  the  world;  each  having  a  con- 
venient room  and  apartment  to  themselves,  where  they  are  locked  up 
at  night,  and  in  it  a  place  for  a  bed,  or  if  they  are  so  senseless  as  not  to 
be  fit  to  make  use  of  one,  they  are  every  day  provided  with  fresh,  clean 
straw.  Those  that  are  fit  for  it,  at  convenient  hours  have  liberty  to  walk 
in  the  long  galleries,  which  are  large  and  noble.  For  the  Summer  time, 
to  air  themselves,  there  are  two  large  grass  plats — one  for  the  men,  the 
other  for  the  women;  in  the  Winter,  a  stove  for  each  apart,  w^here  a 
good  fire  is  kept  to  warm  them.  In  the  hot  weather,  a  very  convenient 
bath  place  to  cool  and  wash  them;  which  is  of  great  service  in  airing 
their  lunacy,  and  is  easily  made  a  hot  bath  for  restoring  their  limbs 
when  numb,  or  cleaning  and  preserving  them  from  scurvy,  etc.  Their 
diet  is  extraordinary  good  and  proper  for  them,  which  every  week  is 
viewed  by  a  committee  of  the  Governors.  *  *  *  There  is  nothing 
of  violence  suffered  to  be  ottered  to  any  patient,  but  they  are  treated 
with  all  the  care  and  tenderness  imaginable.  If  raving  or  furious,  they 
are  confined  from  doing  themselves  or  others  mischief;  and  it  is  to  the 
credit  of  the  hospital  that  in  so  great  a  number  of  lunatics  that  are  con- 
stantly kept  there,  it  is  very  rare,  in  many  years,  any  one  jDatient  makes 
away  with  himself.  *  *  *  The  time  of  cure  is  uncertain ;  some  have 
been  cured  in  a  month,  others  in  two  or  three,  and  some  continue  dis- 
tracted many  years."    This  was  written  early  in  the  eighteenth  century.* 

In  seventeen  hundred  and  thirty-four,  considerable  additions  were 
made  to  Bethlem,  and,  in  consequence  of  its  still  proving  inadequate  to 
meet  the  demand.  Saint  Luke's  Hospital  was  established  in  seventeen 
hundred  and  fifty-one,  by  voluntary  subscription.  It  was  situate  on  the 
north  side  of  Upper  Moorfields,  in  a  locality  called  Windmill  Hill. 

From  this  period  to  the  latter  part  of  the  eighteenth  century  but 
little  progress  was  made  in  the  treatment  of  the  insane,  and  in  the  con- 
dition of  the  houses  where  they  were  received;  indeed,  as  respects 
Bethlem  it  is  probable  that  its  state  had  retrogaded  rather  than  advanced. 
In  the  middle  of  the  century  (seventeen  hundred  and  fifty -five)  a  work 
was  published  the  title  of  which  appears  significant,  this  was  "  Folly 
Predominant;  with  a  Dissertation  on  the  Impossibility  of  Curing  Luna- 
tics in  Bedlam."  From  time  to  time  during  this  period  a  work  made  its 
appearance  on  the  subject  of  insanity.  Thus,  in  seventeen  hundred, 
Herwig  published  his  "Art  of  Curing  Sympathetically  or  Magnetically; 
with  a  Discourse  on  the  Cure  of  Madness;"  and,  five  years  later  Fal- 
lowes  enlightened  the  world  with  his  "Method  of  Curing  Lunatics." 


"*In  the  General  Eegulation  of  Bethlem  Hospital  for  1792  we  find  the  following  orders: 

"  No  lunatic  shall  be  put  in  chains  without  the  instructions  or  approval  of  the  apothecarj'. 

"  The  feet  of  the  lunatics  who  are  chained  shall  be  carefully  examined,  well  rubbed  and 

covered  with  flannels  every  morning  and  evening  through  the  Winter;  and  if  aiw  morbid 

symptoms  require  the  presence  of  the  surgeon,  he  shall  at  once  be  informed."— Sections  9 

and  10. 


96 

Blakeway  wrote  in  seventeen  hundred  and  seventeen  (  "Essay  toward 
the  Cure"  of  Eeligious  Melancholy,")  and  Frings  in  seventeen  hundred 
and  forty-six  (Treatise  on  Phrensy.)     Batty  wrote  his  treatise  on  mad- 
ness in  seventeen  hundred  and  fifty-seven.     But  none  of  these  works 
deserved  or  gained  much  reputation.     Perfect,  whose  first  work  on  the 
subject  was  written  in  seventeen  Hundred  and  seventy-eight,  made  some 
valuable  contributions  to  the  knowledge  th>n  possessed  regarding  insan- 
ity.    His  treatment  appears  to  have  consisted  chiefly  in  venesection, 
emetics,  setons,  digitalis,  antimony,  and  electricity.     Dr.  T.  Arnold  pub- 
lished the  first  edition  of  his  excellent  "  Observations  on  the  nature, 
kinds,  etc.,  of  Insanity,"  in  seventeen  hundred  and  eighty-two.     This 
work,  however,  contains  little  or  nothing  in  regard  to  treatment.     A 
few  years  afterwards  (seventeen  hundred  and  eighty-nine),  "  A  Treatise 
on  the  real  cause  and  cure  of    Insanity,"  was  published  by  Harper, 
which,  although  it  possesses  no  merit,  has,  however,  the  honor  of  hav- 
ing been  criticised  by  Pinel.     In  seventeen  hundred  and  ninety  appeared 
''  Observations  on  the  general  and  improper  treatment  of  Insanity,"  by 
Faulkner;  and  the  "Observations  on  Maniacal  Disorders,"  by  Pargeter, 
in  seventeen  hundred  and  ninety-two.      But   none   of   these  writings 
appear  to  have  exercised  any  material  effect  in  ameliorating  the  condi- 
tion of  the  insane  in  England!^     This,  unfortunately,  is  but  too  correctly 
described  in  the  following  graphic  sketch  from  the  pen  of  Dr.  W.  A.  F. 
Browne  ("What  Asylums  were,  are,  and  ought  to  be:")     "Let  us  pass 
a  few  minutes,"  he  says,  "'in  an  asylum  as  formerly  regulated,  and  from 
the  impression  made  W  so  brief  a  visit  let  us  judge  of  the  effects  which 
years  or  a  lifetime   spent  amid  such  gloomy  scenes  were  calculated  to 
produce.     The  building  is  gloomy,  placed  in  some  low  confined  situation, 
without  windows  to  the  front,  every  chink  barred  and  grated — a  perfect 
gaol.     As  you  enter  a  creak  of  bolts  and  the  clank  of  chains  are  scarcely 
distinguishable  amid  the  wild  chorus  of  shrieks  and  sobs  which  issue 
from  every  apartment.     The  passages  are  narrow,  dark,  damp,  exhale  a 
noxious  effluvia,  and  are  provided  with  a  door  at  every  two  or  three 
yards.     Your  conductor  has  the  head  and  visage  of  a  Carib;  carries  (fit 
accompaniment)  a  whip  and  a  bunch  of  keys,  and  speaks  in  harsh  mono- 
syllables.    The  first  common  room  you  examine — measuring  twelve  feet 
long  by  seven  wide,  with  a  window  which  does  not  open — is  perhaps  for 
feniales.     Ten  of  them,  with  no  other  covering  than  a  rag  roiind  the 
waist,   are   chained   to   the   wall,  loathsome    and   hideous;    but,   when 
addressed,  evident!}^  retaining  some  of  the  intelligence  and  much  of  the 
feeling  which  in  other  days  ennobled  their  nature.     In  shame  or  sorrow, 
one  of  them  perhaps  utters  a  cry;  a  blow,  which  brings  the  blood  from 
the  temple,  the  tear  from  the  eye — an  additional  chain,  a  gag,  and  inde- 
cent or  contemptuous  expression — produce  silence.    And  if  3^ou  ask  where 
these  creatures  sleep,  you  are  led  to  a  kennel  eight  feet  square,  with  an 
unglazed  airhole   eight  inches  in   diam.eter.     In  this,  you  are  told,  five 
women  sleep.     The  floor  is  covered,  the  walls  bedaubed  with  filth  and 
excrement;  no  bedding  but  wet  decayed  straw  is  allowed,  and  the  stench 
is  so  insupportable  that  you  turn  away  and  hasten  from  the  scene." 

"  From  the  evidence  given  before  the  memorable  committee  of  the 
House  of  Commons,  in  eighteen  hundred  and  fifteen,  notwithstanding 
the  equivocation  and  evasion  Avhich  marked  many  of  the  replies,  it  is  not 
difficult  to  form  an  estimate  of  the  condition  of  the  English  asylums 
generally,  more  especially  the  York  Asylum  and  Bethlem  Hospital. 
Nor  was  the  condition  in  which  they  were  found  at  that  period  alone 
revealed;  their  past  condition  was  at  the  same  time  rendered  manifest. 


97 

"A  miserable  and  empirical  routine  marked  the  treatnurt.  To  the 
question:  '  Has  there  not  been  a  rule  in  the  hospital  for  a  certain  number 
of  years  that,  in  certain  months  of  the  year,  particular  classes  of  the 
patients  should  be  physicked,  bled,  bathed,  and  vomited  at  given  peri- 
ods? ■  the  re-ply  from  Bethlem  was  in  the  affirmative.  Twice  in  the  year 
the  patients,  with  few  exceptions,  were  bled.  'After  they  have  been 
bled,'  said  the  physician,  in  evidence,  'they  take  vomits  once  a  week,  for 
a  certain  number  of  weeks;  after  that,  we  purge  the  patients.  That  has 
been  the  practice,  invariably,  for  years — long  before  my  time.' 

"  In  regard  to  the  means  of  coercion  employed,  it  was  stated  that  the 
patients  '  are  generally  chained  to  the  wall  with  manacles.'  When  in- 
quiry was  made  regarding  the  use  of  strait  waistcoats,  it  was  replied,  '  I 
do  not  believe  there  are  any  strait  w^aistcoats  in  Bethlem  now,  or  very 
few  indeed;  they  generally  use  irons.'  The  objection  to  strait  waistcoats 
was  that  the  patients  '  could  not  help  themselves  in  strait  waistcoats; 
they  are  so  exceedingly  long  in  the  hospital  without  being  seen  by  any- 
body, in  a  dark  place;  in  Winter,  from  four  o'clock  to  six  or  seven  in  the 
morning.  If  they  were  in  a  strait  waistcoat  they  could  not  assist  them- 
selves the  least  in  the  world.'  When,  in  the  following  year,  the  head 
keeper  of  Bethlem  Hospital  was  asked  :  '  Was  it  not  the  practice  in  old 
Bethlem — not  in  the  late  gallery,  but  in  the  gallery  pulled  down — for 
eight,  ten,  or  more  patients  to  be  fastened  to  the  tables,  almost  in  a  state 
of  perfect  nakedness?'  he  replied:  'Yes;  they  used  to  think  they  tore 
their  clothes  all  to  pieces;  some  of  them  would  do  that.'  'In  point  of 
fact,  were  they  not  fastened  to  the  tables,  sitting  in  a  state  of  perfect 
nudity?  '  Answer — 'They  used  to  be  so  at  the  table;  they  were  chained 
all  around.'  " 

With  these  records  of  the  barbarity  and  cruelty  practiced  in  the  asy- 
lums of  England,  and  so  forcibly  described  in  the  able  work  of  Bucknill  & 
Tuke,  from  which  they  have  been  quoted,  we  need  not  be  surprised  at  their 
having  been  made  the  basis  of  a  sensational  novel  by  Charles  Eead,  even 
after  they  had  ceased  to  exist,  nor  that  the  prejudices  against  these  in- 
stitutions should  still  hold  a  place  in  the  minds  of  the  people  everywhere. 

THEIR   CONDITION   IN   FRANCE. 

Esquirol  says  of  the  insane  in  France:  "  I  have  seen  them  naked  or 
covered  with  rags;  with  nothing  but  a  la^^er  of  straw  to  protect  them 
from  the  cold  dampness  of  the  ground  upon  which  they  lay.  They  were 
kept  upon  food  of  the  coarsest  kind;  they  were  deprived  of  fresh  air  to 
breathe,  and  of  water  to  quench  their  thirst,  and  even  of  the  most  neces- 
sary things  of  life.  I  have  seen  them  given  up  to  the  brutal  supervision 
of  jailors.  I  have  seen  them  in  their  narrow  cells,  filthy  and  unwhole- 
some, without  air  or  light,  chained  in  such  dens  as  one  might  fear  to 
confine  ferocious  beasts."  "Similar  to  these  were  the  abodes  of  the 
insane  throughout  Europe." 

IN    ROME   AND   LIMERICK. 

"  In  Eorae  iron  rings,  armed  with  chains,  and  fixed  in  the  wall,  serve 
to  confine  the  furious  and  turbulent  maniacs,  who  are  fastened  by  their 
necks  and  feet."  "In  one  room  were  two  rings  fixed  to  the  wall;  one 
ring  was  to  embrace  the  neck,  the  other  the  ankle,  and  the  poor  maniac 
was  doomed  to  stand  or  suspend  himself  by  the  neck."     "  The  accommo- 

13 


98 

dations  in  the  asylum  at  Limerick  appear  to  "be  such  as  we  should  not 
appropriate  for  our  dog  kennels."  ''One  victim  was  confined  in  one  of 
the  oblong  troughs,  chained  down.  He  had  evidently  not  been  in  open 
air  for  a  considerable  time,  for  when  I  made  them  bring  him  out  he 
could  not  endure  the  light.  Upon  asking  him  how  often  he  had  been 
allowed  to  get  out  of  the  trough,  he  said:  'Perhaps  once  a  week,  and 
sometimes  not  for  a  fortnight.'  He  was  not  in  the  least  violent;  he  was 
perfectly  calm."* 

IN    THE    GERMANIC    CONFEDERATION. 

In  eighteen  hundred  and  forty-five  the  Journal  Psychiatric  and 
Psychological  Medicine  was  established,  with  Doctor  Damerow,  of  the 
institution  in  Halle,  as  its  principal  editor,  and  Doctors  Flemming  and 
Poller — the  latter  of  the  lUenaw  Asylum — as  associates.  Although 
printed  at  Halle,  as  a  matter  of  convenience  to  Doctor  Damerow,  it  is 
published  at  Berlin.  If  an  opinion  may  be  formed  from  the  vigor  with 
which  it  has  been  conducted,  as  well  as  the  long  list  of  collaborators — 
men  distinguished  as  physicians  of  the  insane  or  for  their  knowledge  of 
psychical  medicine  and  the  jurisprudence  of  insanity,  not  in  Germany 
alone,  but  in  Denmark,  Holland,  and  Switzerland — it  will  not  lack  for 
material,  and  is  established  ui)on  a  permanent  basis.  Its  editor  in  chief 
is  one  of  the  most  prominent  advocates  of  the  doctrines  of  the  Psycho- 
Somatic  school,  but  both  his  associates  are  Somatics.  Among  its  col- 
laborators are  found  all  the  gradations  of  theory  from  the  somatic  to 
the  psychic. 

Since  the  death  of  Heinroth,  Dr.  Ideler,  of  Berlin,  is  the  acknowledged 
leader  of  the  psychic  school.  But  as  time  has  progressed  the  Conflict  of 
opinion  has  measureably  subsided.  The  attention  of  physicians  has 
been  diverted  from  the  comparatively  barren  field  of  hypothetical  con- 
troversy to  the  more  useful  domain  of  practical  science,  the  improve- 
ment of  hospitals,  and  the  treatment  of  their  inmates. 

From  the  foregoing  historical  sketch,  chiefly  of  the  literature  of 
insanity,  it  may  be  justly  inferred  that  little,  if  anything,  was  done 
during  the  last  century  for  the  improvement  of  the  receptacles  for  the 
insane  in  Germany.  The  initiative,  however,  was  taken  even  in  the  few 
writings  which  were  i^ublished,  as  these  were  the  preliminary  steps 
which  led  to  more  important  practical  action.  The  asylum  at  Vienna, 
but  of  late  years  not  very  favorably  known  as  the  Narrenthurm,  was 
completed  and  oj^ened  in  seventeen  hundred  and  eighty-four,  and  was 
at  that  2)eriod  the  best  establishment  of  the  kind,  as  it  was  the  only  one 
exclusively  devoted  to  the  insane,  throughout  the  German  nations.  As 
the  eighteenth  century  was  departing,  Heinroth,  having  finished  his 
studies  at  Paris,  carried  the  principles  of  his  illustrious  preceptor  within 
the  German  borders,  and  thus  added  a  new  and  important  element  to  the 
cause  of  improvement.  An  idea  of  the  condition  of  the  German  asylums 
at  the  commencement  of  the  present  century  may  be  derived  from  the 
language  of  one  of  their  native  authors,  Peil,  who,  in  his  "  Phapsodies 
upon  tlie  aj^plication  of  the  Psychical  Curative  Treatment  in  Mental 
Disorders,"  published  in  eighteen  hundred  and  three,  wrote  as  follows: 
"  They  are  mad-houses,  not  merely  by  reason  of  their  inmates,  but  more 
especially  because  they  are  the  very  opposite  of  what  they  were  intended 
to  be.     They  are  neither  curative  institutions  nor  such  asylums  for  the 

*  Browne's  Lectures,  Edinburgh,  1837. 


99 

incurable  as  humanity  can  tolerate;  they  are  for  the  most  veritable  dens. 
Has  man  so  little  respect  for  the  jewel  which  makes  him  man,  or  so 
little  love  for  his  neighbor  w4io  has  lost  that  treasure,  that  he  cannot 
extend  to  him  the  hand  of  assistance  and  aid  him  in  regaining  it?  Some 
of  these  receptacle  are  attached  to  hospitals,  others  to  prisons  and  houses 
of  correction;  but  all  are  deficient  in  ventilation,  in  the  facilities  for 
recreation;  in  short,  they  are  w^anting  in  all  the  physical  and  moral 
means  necessary  to  the  cure  of  their  patients."* 

OBSERVATIONS   UPON   FOREGOING    SUBJECTS. 

The  foregoing  extracts  from  various  well  known  authorities  have  been 
made  not  only  to  show  the  condition  of  the  insane,  the  character  of  the 
establishments  in  which  they  were  kept,  and  the  methods  of  treatment 
adopted  and  pursued  in  such  cases  by  the  most  learned  and  eminent 
men  in  the  several  countries  under  consideration,  but  also  to  direct 
attention  to  the  fact  that  though  sundry  efforts  had  been  made  by  men 
of  learning  and  ability  to  establish  journals  of  mental  science  in  Ger- 
many during  the  latter  part  of  the  eighteenth  and  early  part  of  the 
nineteenth  centuries,  they  all  signally  failed,  not  from  lack  of  ability  on  the 
part  of  those  who  edited  and  conducted  them,  but  for  want  of  suj^port  by 
the  public.  The  first  of  these  magazines  was  commenced  in  seventeen  hun- 
dred and  eighty-three,  but  lived  only  a  short  time.  The  next  periodical 
devoted  exclusively  to  the  subject  of  insanity  was  (-stablished  by  Doctor 
Eeil,  and  published  at  Halle,  in  Prussian  Saxony,  in  the  year  eighteen 
hundred  and  five,  the  philosopher  Ivayssler  having  contributed  largely 
to  its  pages.  It,  too,  soon  shared  the  fate  of  its  predecessor,  and  died 
for  the  want  of  appreciation  and  support,  too  little  interest  as  yet  being 
felt  in  a  class  of  persons  supposed  to  be  possessed  by  devils.  In 
eighteen  hundred  and  eighteen  Nasse  made  another  effort,  and  com- 
menced his  Journal  of  Psychological  Medicine,  and  being  conducted  with 
great  ability  and  unusual  zeal,  awakened  a  more  lively  interest  in  the 
subject  and  its  unfortunate  victims.  But  the  time  for  success  had  not 
yet  arrived,  and  after  a  desperate  struggle  for  eight  years  it,  too,  w^ent 
down  to  join  the  list  of  the  departed.  Still  another  journal  was  started 
in  eighteen  hundred  and  twenty-nine;  and  yet  another,  by  Doctors 
Jacobie  and  Flemming,  in  eighteen  hundred  and  thirty-eight,  but  all 
\yith  similar  results.  Many  valuable  essays  and  books  have  m  the  mean 
time  been  given  to  the  world  by  various  German  writers;  but  it  was  not 
till  eighteen  hundred  and  forty-five,  as  already  stated,  that  a  journal 
was  established,  with  Daraerow^  of  Halle  as  its  head,  and  Flemming  and 
liolier — the  latter  still  at  Illenaw — as  assistants,  that  a  psychological 
journal  has  been  able  to  stem  the  current  and  stand  the  test  of  time. 

Since  that  time  many  able  writers  have  aj^peared  upon  the  field  of 
psychological  medicine  and  made  valuable  contributions  to  science. 
Among  these,  none  stood  higher  either  at  home  or  abroad  than  the 
lamented  Griesinger,  who  has  left  behind  him  in  his  works  a  monument 
more  grand,  beatitifiil  and  enduring  than  any  that  could  be  erected  of 
marble  or  bronze. 

It  is  also  worthy  of  notice  that  there  was  but  one  public  asylum  in  all 


*Institiitions  for  the  Insane  in  Germany,  by  Pliny  Earle,  M.  D. 


100 

Germany  in  seventeen  hundred  and  eighty-four''' — the  ''  Xorrenthurm  " 
at  Vienna — while  at  the  present  time,  as  will  be  seen  in  the  list  of  asy- 
lums in  the  German  Confederation,!  there  are  ninety-two  public  and 
forty-nine  yjrivate  institutions  devoted  to  the  care  and  maintenance  of 
this"^  hitherto  neglected  class  of  human  beings.  And  although  most  of 
these  do  not  come  up  to  our  ideas  of  first  class  asylums,  as  viewed  from 
an  American  or  English  standpoint;  nevertheless,  some  of  them  are  well 
built,  conveniently  arranged  and  ably  conducted,  and  would  be  a  credit 
to  any  country.  Indeed,  it  may  be  said  that  very  nearly  all  of  those 
established  within  the  last  twenty  years  are  of  this  class. 

CRUEL  TREATMENT  THE  RESULT  OF  IGNORANCE. 

It  would  appear  strange  indeed,  and,  if  we  did  not  know  to  the  con- 
trary, absolutely  incredible,  that  such  cruelties,  such  barbarous  practices 
as  have  been  noticed  in  the  foregoing  pages  could  have  been  tolerated  for 
so  long  a  time  among  the  refined,  intelligent,  and  highly  civilized  people 
of  Europe  without  a  single  effort — previous  to  the  French  revolution — 
on  the  part  of  humanity  to  relieve  the  distresses  of  this  class  of  their 
fellow  creatures.  Ignorance,  in  law,  is  no  excuse,  and  yet  ignorance  is 
the  only  excuse  that  mankind  can  ofter  for  the  neglect  of  these  wretched 
creatures.  They  w^ere  regarded  during  these  long  centuries  as  being 
possessed  of  devils,  as  enemies  of  society,  and  as  doomed  forever,  so 
soon  as  they  were  known  to  be  madmen.  Even  yet  this  idea  has  not 
been  eradicated  from  the  minds  of  some  people,  while  many  still  believe 
the  disease  to  be  incurable  from  the  beginning,  and  its  accession  a  dis- 
grace to  the  unfortunate  victim  and  his  family.  It  is  high  time  I'or  the 
people  to  lay  aside  these  false  notions,  and  accej^t  the  fact  that  insanity 
is  simply  the  eftect  of  a  diseased  brain,  and  that  all  persons  are  liable  to 
its  invasion. 

NEW   YORK   POORHOUSES. 

But  let  us  look  into  this  matter  at  home,  and  see  if  we  cannot  find  that 
these  abuses  and  cruel  practices,  unfortunately,  have  not  been  confined 
to  English  and  continental  institutions.  The  following  extracts  will 
show  their  condition  in  the  poorhouses  of  New  York  at  a  comparatively 
recent  period.  In  eighteen  hundred  and  fifty-seven  a  committee,  consist- 
ing of  Mark  Spencer,  George  Bradford,  and  M.  Lindley  Lee,  reported  the 
results  of  inquiries  and  examinations  made  the  Summer  before.  The  fol- 
lowing sentence  is  from  that  report: 

"  The  poorhouses  throughout  the  State  may  be  generally  described  as 
badly  constructed,  ill  arranged,  ill  warmed,  and  ill  ventilated.  The  rooms 
are  crowded  with  inmates,  and  the  air,  particularly  in  the  sleeping  apart- 
ments, is  very  noxious,  and  to  casual  visitors,  almost  insufterable." 

In  eighteen  hundred  and  sixty-five  a  Committee  of  which  Dr.  Sylvester 
D.  WilTard  was  Chairman  made  a  report,  from  wdiich  we  extract  the  fol- 
lowing: 

*NoTE.— The  Alexianer  Convent  at  Aix-la-Chappelle  has  been  a  receptacle  for  the  insane 
for  five  hundred  years;  and  the  "  Bloekdick"  (private  asylum),  near  Bremen,  was  estab- 
lished in  1750,  and  rebuilt  in  1839. 

fSee  Appendix  B. 


101 

"  It  is  not  without  fi  confession  of  pain  jind  humiliation  that  the  Com- 
missioners announce  the  deplorable  condition  of  the  insane  poor;  the 
'  notorious  and  sickening  abuses  '  which  they  found  in  many  of  the  public 
establishments  known  as  County  Poorhouses.  With  unquestionable  truth 
they  aiiirni  that  '  the  State  has  shifted  off  from  itself  upon  the  counties  a 
duty  which  it  ought  ever  to  have  recognized  as  imperative  and  sacred.' 
Nearly  every  count}^  house  was  visited.  As  the  record  of  particular 
instances  is  more  convincing  and  more  affecting  than  general  statements 
and  summary  conclusions,  a  few  facts  are  condensed  from  the  report,  the 
selection  being  made  from  counties  in  the  Hudson  Eiver  hospital  district. 
Let  us  look  first  at  Albany.  Here,  under  the  shadow  of  the  State  Capi- 
tol, were  seventy-six  insane  persons  shut  up  in  thirty-one  rooms,  each  of 
which  was  intended  and  is  only  large  enough  for  one.  A  number  of 
these  rooms  had  three  occupants  in  each;  the  ventilation  in  some  of 
them  was  very  imperfect.  Notwithstanding  the  deficient  accommoda- 
tions, rendering  all  classification  impossible,  recent  cases  are  frequently 
received  and  held  for  treatment,  with  what  probability  of  improvement 
under  such  conditions  can  easily  be  seen.  The  insane  poor  of  Duchess 
County  are  bestowed  in  eighteen  cells  constructed  in  prison  style,  with 
heavily  grated  doors  and^arred  windows;  board  partitions  separate 
these  cells,  and  wooden  bunks  serve  for  bedsteads;  for  want  of  proper 
appliances  the  cells  cannot  be  made  comfortable  in  cold  weather;  two  of 
the  men  vvere  loaded  with  chains.  For  her  insane  Eichmond  County  has 
provided  four  dark  cells.  One  poor  creature  has  spent  fourteen  years  in 
a  small  outhouse — a  cripple,  bent  nearly  double — and  without  a  rag  of 
clothing!  The  poorhouse  in  Saratoga  County  is  nearly  fifty  years  old; 
the  floors  and  walls  of  this  venerable  structure  are  much  broken,  and 
the  roof  leaks.  Though  not  far  from  the  Ballston  Springs,  the  water  is 
scarce  there.  The  cells  of  the  insane  measure  seven  and  a  quarter  by 
six  and  a  quarter  feet,  and  each  contains  a  wooden  bunk,  and  nothing 
else ;  these  cells  get  all  their  light  and  air  through  gratings  in  the  doors ; 
in  these  dungeons  individuals  have  been  confined  for  ten  and  even  for 
eighteen  successive  years,  never  going  outside,  except  during  the  short 
annual  visits  of  the  Board  of  Supervisors.  In  one  case  there  had  been 
an  illegitimate  birth,  under  circumstances  most  distressing  and  revolting. 
Warren  County  is  thus  described:  'Insane  filthy  in  their  persons,  and 
stench  from  the  place  intolerable.  Four  cells  in  the  building,  all  unfit 
for  use.  Eats  the  only  scavengers.  No  medical  attendance.  Building 
entirely  unsuited  to  the  purpose.'  " 

Very  little  is  said  in  praise  of  Franklin,  Essex,  W^ashington,  Greene,^ 
Putnam,  Sullivan,  AVestchester,  and  Queens  Counties.  At  the  time  of 
the  inspection  the  number  of  insane  persons  who  were  shut  up  in  cells 
or  secured  by  chains  was  two  hundred  and  thirteen.  In  view  of  the 
whole  picture  the  Commissioners  might  well  exclaim:  "  AVill  the  people 
of  New  York,  when  they  comprehend  the  inhuman  treatment  which  the 
insane  poor  sometimes  receive,  leave  a  system  in  unchecked  operation 
which  admits  of  such  enormities?" 

We  are  rejoiced  to  say  that  the  people  of  New  York  have  compre- 
hended this  subject,  and  have  nobly  responded  to  this  question  in  a 
manner  not  to  be  mistaken,  and  with  a  generosity  worthy  of  that  great 
State.  Her  legislators,  advised  and  encouraged  by  her  wise  executive 
officers,  have  made  appropriations,  provided  lands,  selected  sites,  and 
ordered  the  erection  of  asylums  for  the  proper  care  and  treatment  of 
every  insane  person  loit/un  her  borders. 


102 

AMELIORATION     IN     THE    TREATMENT    OF    THE    INSANE     AS     COMPARED    WITH 

FORMER    PERIODS. 

Let  US  call  attention  for  a  moment  to  some  of  the  causes  that  led  to 
an  amelioration  of  the  condition  of  the  insane,  both  in  England  and  on 
the  continent,  and  to  some  of  the  men  who  were  conspicuous  in  directing 
public  opinion  in  so  important  a  matter,  and  instrumental  in  carrying  out 
the  humane  doctrines  they  proclaimed.  A  brief  review  of  the  life  and 
writings  of  Dr.  ConoUy  appeared  in  the  American  Journal  of  Insanity 
for  April,  eighteen  hundred  and  seventy;  a  few  extracts  from  which  will 
subserve  the  purposes  we  have  in  view : 

Former  Coercive  Treatment. 

Few  of  us  in  America  know,  except  from  history  or  from  travel  on 
the  continent,  the  extent  to  which  mechanical  restraints  were  used  in 
Great  Britain  previous  to  eighteen  hundred  and  forty,  and  are  now  in 
the  other  European  countries. 

Dr.  Conolly  found  on  taking  charge  of  the  Asylum  at  Hanwells — 
eighteen  hundred  and  thirty-nine — each  ward  j^rovided  with  a  closet  full 
of  restraining  apparatus,  and  every  attendant  used  them  at  will.  Many 
patients  were  always  in  restraint.  Six  new  restraining  chairs  had  been 
recently  added  to  the  stock,  making  forty-nine  in  all  (pp.  53,  54).  The 
instruments  of  mechanical  restraint  were  so  abundant  as  to  amount, 
when  collected  together,  to  about  six  hundred;  half  of  them  handcuffs 
and  leg  locks  (pp.  18,  20). 

This  may  be  assumed  as  a  specimen  of  the  provision  in  the  asylums  of 
Great  Britain  and  Europe  at  that  time,  and  these  means  nearly  repre- 
sented the  ideas  of  the  people  at  large,  the  governors  or  magistrates 
who  had  the  outer  superintendence  of  these  establishments,  and  the 
physicians  who  had  them  under  their  immediate  charge. 

Finel. 

Although  Pinel  had  wrought  what  was  deemed  almost  miracles  in  set- 
ting the  manacled  maniacs  free  without  evil  consequences  to  those  who 
were  in  contact  with  them,  yet  few  had  dared  to  follow  him,  and  the 
lunatic  remained  in  great  measure  as  he  was  before.  The  world  still 
clung  to  the  faith  of  olden  time — that  the  insane  were  the  devil's  pos- 
sessions, and  those  thus  possessed  should  be,  if  not  punished,  at  least 
restrained,  to  prevent  injury  to  the  fearful  community. 

Treatment  in  Middle  Ages. 

Nevertheless,  there  had  been  a  wonderful  improvement  upon  the  cruel 
customs  of  the  barbarous  ages.  In  those  dark  periods  the  religious 
houses  were  in  some  sort  used  as  hospitals,  and  some  of  them  took  care 
of  the  insane.  At  one  of  these  establishments  of  the  Franciscans,  who 
believed  in  and  practiced  on  themselves  the  severest  mortifications  and 
self-chastening,  the  same  rule  was  applied  to  their  patients,  and  they 
gave  each  lunatic  ten  lashes  a  day.  In  another  each  patient  was  bled 
every  June.  Stripes,  however,  were  but  one  form  of  cruelty,  and  the 
slightest  of  the  kind.  In  the  old  asylums  all  the  most  terrible  engines 
of  torture,  to  carry  out  the  theory  of  punishment,  were  resorted  to. 
The  inventions   to  give  pain  were  marvelous.      There  were  chairs  of 


103 

restraint  in  which  the  patient  could  not  move  limb  or  bod}',  and  whirling 
chairs,  in  which  the  unfortunate  lunatic  was  whirled  at  the  rate  of  one 
hundred  gyrations  a  minute  (p.  47). 

These  and  other  practices  equally  cruel  were  continued  in  Germany 
as  late  as  seventeen  hundred  and  ninety.  In  some  asylums  the  patients 
were  kept  in  a  state  of  partial  famine,  chained,  covered  with  dirt  and 
filth,  but  half  clothed,  and  their  insufficient  clothing  seldom  changed; 
cages  of  iron  were  in  use,  in  which  some  of  the  lunatics  were  kept  for 
years.  These  miseries  were  inflicted,  not  from  carelessness,  but  from 
what  was  believed  to  be  real  humanity  (p.  48). 

In  an  earlier  age,  some  iron  cages  were  made  sufficiently  large  to 
hold  one  or  more  patients.  These  were  movable  and  suspended  by  chains 
over  water,  in  tanks  or  pools,  with  the  patients  standing  in  them;  they 
were  let  down  into  the  water,  until  it  reached  their  chins  or  mouths, 
leaving  them  only  a  breathing  place.  There  they  were  kept  as  long  as 
they  could  endure  the  position  and  the  bath.  This  was  an  established 
part  of  the  treatment  or  punishment.  The  worst  of  these  practices  had 
passed  away  before  the  time  of  Pinel  and  his  followers. 

York  Asylum. 

Among  the  bad,  the  York  Asylum  was  the  worst.  A  female  member 
of  the  Society  of  Friends  being  placed  as  a  patient  in  this  institution  in 
seventeen  hundred  and  ninety-one,  died  under  suspicious  circumstances. 
They  immediately  determined  to  establish  an  asylum  under  their  own 
control,  in  which  there  should  be  no  secrecy.  William  Tuke  was  the 
great  founder  of  this  new  hospital,  and  from  the  first  he  and  his  associ- 
ates pursued  those  j^rincij^les  in  its  management  that  Pinel  was  then  pro- 
posing, and  which  have  now  become  the  established  rule  of  practice  in 
Great  Britain  and  the  United  States.  They  did  not  abolish  all  restraints, 
yet  they  began  this  work,  retaining  only  those  of  the  milder  kind. 

Lincoln  Asylum. 

Dr.  Charlesworth,  in  the  Lincolnshire  Asylum,  in  eighteen  hundred 
and  twenty-one,  began  his  experiments  of  substituting  the  milder  for  the 
severe  restraints.  He  persevered  in  this  great  work  year  after  year, 
regardless  of  opposition  and  undaunted  by  difficulties,  and  at  length 
arrived  at  the  total  abolition,  which  he  found  both  a  practicable  and  a 
more  comfortable  and  successful  method  of  controlling  the  patient.  Mr. 
Gardner  Hill  was  also  engaged  in  the  same  work,  with  the  same  result. 

Br.  Conolly  at  iraniuell. 

Still  chains,  handcuffs,  and  leg  blocks  were  in  general  use  in  the  asy- 
lums of  Great  Britain  and  the  continental  nations  when  Doctor  Conolly 
entered  the  Hanwell  Asylum  as  Eesident  Physician,  on  the  first  of  June, 
eighteen  hundred  and  thirty -nine.  He  was  familiar  with  the  writings 
and  practices  of  Pinel,  Charlesworth,  and  Hill.  He  had  confidence  in 
the  success  of  these  measures  and  in  their  applicability  to  any  other 
hospital.  At  once  he  determined  to  try  the  experiment  on  the  patients 
at  Hanwell. 

He  began  his  work  June  first.  There  were  then  over  forty  under 
mechanical  restraint.  Immediately  he  commenced  removing  the  shackles, 
fetters,  etc.,  from  those  who  were  the  most  promising,  or  who  suffered 


104 

most,  and  proceeded  gradually  until  the  whole  were  removed  in  less  than 
four  months.  In  his  work  on  the  treatment  of  the  insane  he  quotes 
from  the  asylum  records: 

"After  the  first  of  July,  when  1  required  a  daily  return  to  be  made  to 
me  of  the  number  of  patients  restrained,  there  were  never  more  than 
eighteen  so  treated  in  one  day.  After  the  thirty-first  of  July  the  num- 
ber never  exceeded  eight;  after  the  twelfth  of  August  it  never  exceeded 
one,  and  after  the  twentieth  of  September  no  restraints  at  all  were 
employed." 

On  the  thirty-first  of  October,  in  his  first  report  to  the  Quarter  Ses- 
sions, he  said:  "Since  the  twenty-first  of  September  not  one  patient  has 
been  under  restraint.  No  form  of  straight  waistcoat,  no  handcufis,  no 
leg  locks,  nor  any  contrivance  confining  the  trunk  or  limbs,  or  any  of 
the  muscles,  is  now  in  use.  The  coercion  chairs,  about  forty  in  iiumber, 
have  been  altogether  removed  from  the  wards  "  (p.  20). 

In  his  eleventh  and  last  report  he  says:  "For  ten  years  no  hand  or 
foot  has  been  fastened  in  this  large  asylum,  by  day  or  night,  for  the 
control  of  the  violent  or  the  despairing;  no  instrument  of  mechanical 
restraint  has  been  employed,  or  even  admitted  into  the  wards,  for  any 
reason  whatever;  no  patient  has  been  placed  in  a  coercive  chair  by  day 
or  fastened  to  a  bedstead  by  night.  Every  patient,  however  excited  or 
apparently  unmanageable,  arriving  at  the  asylum  in  restraints  has  been 
immediately  set  free,  and  remained  so  from  that  time.  The  results,  more 
and  more  seen  in  every  successive  year,  have  been  increased  tranquility, 
diminished  danger,  and  so  salutary  an  influence  over  the  recent  and 
newly  admitted  and  most  recent  cases,  as  to  make  the  spectacle  of  the 
more  terrible  forms  of  mania  and  melancholia  a  rare  exception  to  the 
general  order  and  cheerfulness  of  the  establishment"  (p.  33). 

Effect  of  Bemoval  of  Mesiraints. 

The  effect  of  this  removal  of  restraints  was  at  once  noticed  in  the 
general  tone  of  the  whole  hospital.  The  excited  were  sooner  calmed, 
the  irritable  less  easily  disturbed,  and  a  general  quiescence  prevailed 
more  than  before.  The  wards  were  managed  with  less  difliculty.  The 
new  sj'stem  tended  to  remove,  as  far  as  possible,  all  causes  of  excite- 
ment from  the  irritable,  to  soothe,  encourage,  and  comfort  the  depressed, 
to  repress  the  violent  by  methods  that  leave  no  ill  effect  on  the  temper, 
no  painful  recollections  in  the  memory,  and  in  all  cases  seize  every 
opportunity  of  promoting  a  restoration  of  the  health}'  exercise  of  the 
understanding  and  the  affections  (p.  27.)  Mania  not  exasperated  by 
severity,  and  melancholia  not  deepened  by  want  of  ordinary  consolations, 
lose  the  exaggerated  characler  in  which  they  were  formerly  beheld. 
Hope  takes  the  place  of  fear,  serenity  is  substituted  for  discontent,  and 
the  mind  is  left  in  a  condition  favorable  to  every  imj)ression  likely  to 
call  forth  salutary  efforts  (p.  28.) 

Effect  of  Br.  ConoUi/s  ITethod  on  other  Physicians. 

Many  physicians,  managers  of  other  institutions  in  Britain,  visited 
Dr.  Conoily,  and  a  few  from  the  continent.  These  became  converts 
to  his  views  and  strong  friends  of  his  plans.  One  asylum  after  another 
followed  him,  until,  be  lore  many  years,  non-restraint  seemed  to  be  the 
universally  accepted  doctrine  of  the  whole  psychological  profession  in 
England  and  Scotland. 


105 

Proof  of  the  Advantage  of  Moral  Treatment. 

As  proof  of  the  advantage  of  moral  over  mechanical  means  of  treat- 
ment, Dr.  Broadhurst  points  to  "  the  general  quietness  and  decorum  of 
his  establishment,  the  cheerful  aspect  of  the  patients,  the  comparative 
freedom  from  acts  of  destructive  violence,  the  large  proportion  con- 
stantly engaged  in  useful  occupation,  a  decreased  mortality,  and  an 
increased  percentage  of  cures."  (p.  78.) 

Mr.  Wilkes,  formerly  Superintendent  of  the  Stratford  Asylum,  now 
Commissioner  of  Lunacy,  writes:  "The  effect  of  the  change  upon  the 
old  inmates  was  in  marked  degree  beneficial." 

The  excitement  of  the  patients  generally  diminished.  They  were 
less  noisy  and  restless  at  night;  destructive  propensities  and  objection- 
able habits  were,  in  many  instances,  overcome.  With  greater  oppor- 
tunities of  doing  mischief,  less  occurred.  And  now,  without  a  window 
in  any  way  protected,  and  a  much  larger  number  of  patients,  there  is 
probably  less  breakage  of  glass  than  there  ever  was.  (p.  79.) 

Reputation  of  Dr.  Conolly. 

He  was  very  much  consulted  in  the  cases  of  the  greatest  importance, 
and  was  considered  the  chief  authority  in  all  matters  of  doubt.  Ever 
affable  and  courteous,  he  drew  many  to  his  house  from  his  own  country 
and  from  abroad,  and  alienists  from  the  continent  and  from  America 
found  and  enjoyed  the  most  cordial  hospitality.  Several  of  the  psycho- 
logical physicians  of  the  greatest  power  on  the  continent  were  among 
his  visitors  and  became  the  strongest  friends  of  his  doctrine  of  non- 
restraint.  Among  these  were  Doctor  Griesinger,  of  Berlin  ;  Baron 
Mundy  and  Meyer,  of  Germany;  Morel,  of  France;  and  Guislain,  of 
Belgium. 

They  used  their  utmost  exertion  to  introduce  the  practice  into  their 
several  countries,  but,  except  in  the  institutions  within  their  immediate 
influence,  they  made  but  few  converts;  and  Continental  Europe  vv^as  yet 
to  accept  the  new  method  and  to  unchain  its  lunatics. 

Doctor  Conolly's  opinions  in  regard  to  the  Management  of  the  Insane. 

In  the  management  of  the  insane  he  considered  the  provision  of  large 
establishments,  however  desirable  as  a  matter  of  economy,  was  at  the 
cost  of  some  of  the  remedial  powers  of  the  institution  and  of  the 
chances  of  restoration  of  the  patients,  and  that  the  proper  conduct  of 
lunatic  as^dums  requires  the  whole  power  of  mind  and  heart  that  belong 
to  the  superintendmg  physician;  and  that  whenever  the  governors  or 
directors  of  each  institution  require  their  medical  officers  to  leave  their 
high  vocation  and  sacred  responsibility  of  watching  mental  disorders 
and  guiding  mental  weakness,  and  give  their  time  and  thought  to  the 
subordinate  matter  of  finance  and  stewardship,  to  collect  bills,  and  watch 
the  market,  they  take  from  the  suffering  patients  a  part  of  that  influence 
upon  which  their  best  hope  of  recovery  is  founded. 

Such  were  the  life  and  character  of  Doctor  Conolly,  and  such  were 
his  works,  as  described  by  his  friend  Sir  James  Clark,  and  as  known,  in 
part,  to  most  of  us.  Few  men  have  fulfilled  a  nobler  destiny;  few  will 
be  remembered  with  more  affection  and  gratitude. 

14 


106 

KIRKBRIDE     ON     RESTRAINT    AND    SECLUSION,    AND    THE    MEANS     OE    AVOIDING 

THEIR    USE. 

Restraint  and  Seclusion. 

The  use  of  mechanical  means  of  restraint  and  the  i)rotraeted  seclu- 
sion of  patients  in  their  rooms — although  the  former  of  them  may  be, 
and  as  I  believe  is,  occasionally  desirable  but  not  absolutely  necessary 
in  the  management  of  our  hospitals  for  the  insane — ought  both  always 
to  be  regarded  as  evils  of  no  trifling  magnitude,  and  to  abate  which,  as 
far  as  j^ossible,  no  effort  should  be  left  untried.  They  both  tend  to 
produce  a  relaxation  of  vigilance,  and  it  cannot  be  too  often  repeated 
that  whatever  tends -to  make  vigilance  unnecessary  is  undesirable  about 
a  hospital  for  the  insane.  Besides  leading  patients  into  bad  habits,  the 
frequent  use  of  the  means  referred  to  in  a  ward  induces  attendants  and 
others  to  look  upon  them  as  a  common  recourse  in  cases  of  difficulty  or 
danger,  to  regard  them  as  their  grand  reliance  in  every  emergency,  and 
to  forget  the  great  power  of  other  measures  that  are  entirely  unobjec- 
tionable— the  value  of  tact  and  kindness  and  sympathy  in  controlling 
the  violence  and  dangerous  propensities  of  the  insane.  And  yet,  with- 
out a  23roper  force  of  attendants  and  an  efficient  classification  the  use  of 
mechanical  means  of  restraint  and  the  protracted  seclusion  of  certain 
classes  of  patients  is  almost  unavoidable. 

Objectionable  as  I  deem  the  use  of  restraining  apparatus  in  a  hospital 
for  the  insane,  it  cannot  be  too  earnestly  insisted  on  that  it  is  no  advance 
to  give  up  mechanical  means  of  restraint  and  to  substitute  the  frequent 
and  long  continued  seclusion  of  the  patients.  Occasionally  an  individual 
may  really  be  more  comfortable  and  much  better  off  in  the  open  air, 
with  some  mild  kind  of  restraining  apparatus  on  his  person,  than  he 
would  be  confined  to  his  room  without  it;  for  this  kind  of  long  contin- 
ued seclusion  is  pretty  sure,  sooner  or  later,  to  lead  to  habits  revolting 
in  themselves  and  most  unfortunate  for  the  future  prospects  of  the 
patient. 

The  subject  is  introduced  here  as  a  reason  why  no  false  notions  of 
economy  should  be  j^ermitted  to  influence  any  Board  of  Trustees  to  ask 
the  Superintendent  of  an  institution  to  attempt  its  management  with  a 
force  so  inadequate  as  to  compel  him,  against  his  better  judgment,  to 
resort  to  means  so  objectionable,  and  w4iich  are  so  destructive  to  the 
comfort  and  proper  treatment  of  his  patients. 

Labor,  Outdoor  Exercise,  and  Amusements. 

Having  referred  to  the  unfavorable  results  of  an  habitual  use  of 
restraint  and  seclusion  in  a  hospital  for  the  insane,  it  is  proper  to  indi- 
cate in  more  detail  some  of  the  means  by  which  those  unfortunate  effects 
may  be  obviated. 

A  properly  constructed  building,  admitting  of  a  liberal  classification 
of  the  patients,  and  the  employment  of  an  adequate  number  of  intelli- 
gent and  kind  assistants,  is  indispensable  for  such  an  object.  The 
design  in  establishing  every  such  institution  being  the  restoration  and 
comfort  of  the  afflicted,  the  relief  of  their  families,  and  the  protection  of 
the  community,  there  can  be  no  question  but  that  it  is  sound  economy 
to  provide  everj^thing  that  will  effect  these  objects  promptly  and  in  the 
most  thorough  manner. 

Without  adequate  provision  for  outdoor  exercise  and  occupation  for 


107 

the  patients,  and  a  liberal  supply  of  means  of  amusement,  the  excite- 
ment of  the  wards  and  the  violent  and  mischievous  propensities  of  their 
inmates  will  be  apt  to  be  such  as  to  require  modes  of  manaf^ement  that 
might  otherwise  be  easily  dispensed  with.  The  first  cost  of  some  of 
these  arrangements  will  necessarily  be  considerable,  but  the  ultimate 
results  can  hardly  fail  to  be  so  gratifying  as  to  satisfy  the  most  rigid 
stickler  for  economy  that  the  only  wise  course  is  to  provide  liberally  of 
everything  likely  to  be  beneficial  to  the  patients. 

The  farm  and  garden  otfer  admirable  means  of  useful  occupation  to 
the  insane  at  certain  periods  of  the  disease;  for,  useful  as  they  are  to  a 
large  number,  no  greater  indiscretion  could  be  committed  than  attempt- 
ing to  set  all  insane  men  at  work  in  every  stage  of  their  malady. 

To  those  accustomed  to  such  pursuits,  as  well  as  to  many  who  have 
been  dilferently  occupied,  regular,  moderate  labor  in  the  open  fields  or  in 
the  garden  contributes  most  essentially  to  their  comfort  and  tends  to 
promote  their  recovery.  Labor,  then,  is  one  of  our  best  remedies;  it  is 
as  useful  in  improving  the  health  of  the  insane  as  in  maintaining  that  of 
the  sane.  It  is  one  of  the  best  anodynes  for  the  nervous;  it  composes 
the  restless  and  excited;  promotes  a  good  appetite  and  a  comfortable 
digestion,  and  gives  sound  and  refreshing  sleej)  to  many  who  would  with- 
out it  ]3ass  wakeful  nights. 

The  provision  of  adequate  and  comfortable  w^orkshops,  in  a  convenient 
position  and  under  the  care  of  competent  superintendents,  may  be  made 
a  source  of  profit  to  an  institution,  and  furnish  another  means  of  labor 
of  an  interesting  kind  to  a  large  number  of  the  insane. 

The  usual  means  of  amusement,  which  demand  active  muscular  exer- 
cise, should  not  be  neglected.  A  gymnasium,  suitable  in  its  fitting  up 
for  insane  men,  and  a  calistheneum  for  insane  women,  will  be  found  use- 
ful. The  various  games  of  ball;  the  exercise  of  using  a  car  on  a  circular 
railroad;  the  care  of  domestic  animals,  as  well  as  regular  walks  on  the 
grounds  or  in  the  neighborhood,  are  also  among  the  kinds  of  exer- 
cise that  will  be  enjoyed  by  many  patients;  while  means  of  carriage 
riding  seem  almost  indispensable  for  many,  who  from  physical  and  other 
causes  cannot  resort  to  the  more  active  forms  which  have  already  been 
referred  to. 

Within  doors  the  means  of  keeping  a  comfortable  house  are,  in  addi- 
tion to  the  medical  treatment,  the  constant  presence  among  the  patients 
of  intelligent  attendants,  active  suj^ervisors,  and  judicious  teachers  or 
companions,  always  ready  to  check  the  commencement  of  excitement,  to 
separate  quarrelsome  individuals,  and  to  change  the  train  of  thought  of 
those  who  seem  disposed  to  be  troublesome.  The  means  to  efi:ect  the 
objects  in  view  are  very  numerous,  and  the  tact  of  an  individual  is  shown 
in  selecting  those  that  are  most  applicable  to  a  case. 

The  introduction  of  regular  courses  of  lectures,  interesting  exhibi- 
tions of  various  kinds,  and  musical  entertainments  in  the  lecture  rooms 
of  our  hospitals  for  the  insane,  has  done  much  to  break  up  the  monotony 
of  hospital  life,  which  is  so  common  a  source  of  comj^laint  among  the 
insane. 

liegular  courses  of  instruction  in  well  furnished  school  rooms,  reading 
aloud  by  the  teachers  to  the  patients  of  the  more  excited  wards,  the  use 
of  well  selected  libraries,  the  inspection  of  collections  of  curiosities,  the 
use  of  musical  instruments  and  various  games,  are  all  among  the  many 
means  which  an  ingenious  Superintendent  will  suggest  for  the  benefit 
and  amusement  of  his  jDatients,  and  which  ought  to  be  provided  for  in 
every  institution  for  the  insane. 


108 

In  most  of  the  asylums  in  the  United  States  the  dance  is  either  added 
to  this  list  or  substituted  instead  of  some  of  its  items.  It  is  a  favorite 
amusement  among  the  patients  wherever  it  is  allowed;  and  we  have  been 
informed  by  some  of  the  Superintendents  that  patients  will  often  con- 
trol themselves  for  a  whole  week  with  a  promise  that  they  may  be 
allowed  the  privilege  of  going  to  the  next  dance. 


CHAPTER  IX. 
INSANE  ASYLUMS,  LOCATION,  SIZE,  SITES,  ETC. 

Location — Influence  that  Distance  ought  to  have  on  Location— Effect  of  Multiplying 
Hospitals— Effects  of  Eailroads  and  other  Facilities  of  Travel— Hospitals  Better 
Known  to  Neighboring  People— Observations  on  Foregoing  Topic? — New  Yoik  State 
Lunatic  Asylums— General  Suggestions— Propositions  relative  to  the  Structure  and 
Arrangements  for  American  Institutions  for  the  Insane— English  Lunacy  Coinmis- 
sioners  on  Sites,  Construction,  Size,  etc. — Suggestions  of  the  Scotch  Board— Size  of 
Hospitals— Quantity  of  Land  Necessarj'- Comments  upon  Kirkbride's  Yiewjj. 

LOCATION. 

The  location  of  an  asylum  has,  perhaps,  as  great  an  influence  over  its 
usefulness  as  any  other  matter  connected  with  its  establishment,  and 
those  to  whom  this  important  trust  may  be  delegated,  here  or  elsewhere, 
cannot  be  too  careful  with  the  selection  they  may  make.  There  are 
certain  general  rules  that  should  never  be  overlooked  nor  disregarded  by 
them,  as  on  their  action  may  depend,  in  a  great  degree,  the  success  of 
the  asylum  to  be  established  at  the  present  time,  as  well  as  those  that 
must,  in  the  progress  of  events,  come  after  it. 

The  admissions  in  our  Asylum  during  the  last  ten  years  was  an 
average  of  three  hundred  and  fiftj^-eight  each  year,  and  the  average 
annual  increase  has  been  sixty-seven.  If  w^e  take  a  shorter  period, 
these  numbers  will  be  augmented.  We  see  by  the  report  of  Dr.  Shurt- 
leff,  that  "  for  the  past  five  years  the  annual  admissions  have  averaged 
about  four  hundred  and  fifty,  and  the  net  increase  has  been  about 
eighty."  With  the  increasing  population,  we  may  estimate  with  cer- 
tainty that  no  decrease  in  these  numbers  will  take  place,  if  indeed,  in 
the  providence  of  God,  and  the  better  habits  of  the  people,  it  be  per- 
mitted to  remain  at  these  figures.  This  proportion  of  increase  would 
give  us  eight  hundred  additional  insane  persons  in  the  next  ten  years. 
But  let  us  suppose  that  insanity  will  continue  in  its  present  ratio  to  the 
population,  or  one  to  four  hundred  and  eighty-nine  inhabitants,  and  that 
the  population  increases  no  more  in  the  next  decade  than  during  the 
last,  and  it  will  be  seen  that  more  than  eight  hundred  will  be  added  to 
the  regiment  of  insane  men  and  women  already  in  our  Asylum  at 
Stockton.  It  therefore  behooves  us,  in  any  present  provision  Ave  may 
make  to  meet  the  pressing  necessities  of  immediate  demands,  to  look 
wisely  to  the  future,  and  so  shape  our  action  that  it  may  have  its  proper 
bearing  on  similar  provision  to  be  made  at  some  subsequent  and  not  dis- 
tant time  to  come. 


109 

INFLUENCE    THAT   DISTANCE     OUGHT    TO    HAVE    ON    LOCATION. 

That  the  importance  of  locating  an  asylum  in  convenient  proximity 
to  the  greatest  number  Avho  will  be  likely  to  require  its  use  may  bo 
thoroughly  understood  and  appreciated,  we  have  made  the  following 
extracts  from  a  Treatise  on  the  Influence  of  Distance  from  and  Nearness 
to  an  Insane  Hospital  on  its  Use  by  the  People,  prepared  for  the  State 
of  New  York,  by  Edward  Jarvis,  M.  D.: 

"An  insane  hospital  is,  and  must  be  to  a  certain  extent,  a  local  insti- 
tution. People  will  avail  themselves  of  its  privileges  in  soijie  proportion 
to  their  nearness  to  it.  No  liberality  of  admission,  no  excellence  of  its 
management,  no  power  of  reputation  can  entirely  overcome  the  obstacle 
of  distance,  expense,  and  of  the  difficulties  of  transporting  lunatics,  or 
the  objection  of  friends  to  sending  their  insane  patients  far  from  home, 
and  out  of  the  reach  of  ready  communication. 

"  The  operation  of  this  principle,  in  some  degree,  seems  probable  to 
any  one  who  gives  a  thought  to  the  matter;  but  the  facts,  the  particular 
history  of  those  institutions  in  which  the  records  of  the  homes  of  their 
patients  are  kept,  show  that  the  objection  of  distance  prevails  with  all 
of  them,  and  that  those  hospitals  have  been  and  are  used  by  those  who 
live  near  by  much  more  than  by  those  who  live  farther  off;  and  conse- 
quently they  are  practically  much  more  local  in  their  usefulness  than 
they  are  intended  or  are  supposed  to  be. 

"  The  State  Hospital  at  Utica  was  opened  in  eighteen  hundred  and 
forty-three,  and  offered  to  the  people  of  every  county,  both  near  and 
remote,  on  the  same  conditions.  The  people  of  Oneida,  Schoharie, 
Orange,  Washington,  and  Chautauqua,  were  alike  invited  to  send  their 
insane  on  the  same  terms.  Between  them  there  was  and  could  be  no 
difference  of  advantage  after  their  patients  should  be  placed  in  the  hos- 
pital; the  only  difference  was  in  the  distance  between  their  homes  and 
the  institution,  in  the  labor,  cost,  and  burden  of  traveling  to  a  hospital 
with  a  lunatic.  To  make  this  matter  more  certain  and  to  show  the  dif- 
ference of  enjoyment  to  the  eye,  the  whole  State  has  been  divided  into 
four  districts,  according  to  their  distance  from  the  hospital. 

"  The  First  District  is  Oneida  County,  in  which  the  hospital  is 
situated.' 

"  The  Second  District  consists  of  eleven  counties:  Chenango,  Cortland, 
Fulton,  Herkimer,  Lewis,  Madison,  Montgomery,  Onondagua,  OsAvego, 
Otago,  Schoharie.     These  are  mostly  within  sixty  miles  of  Utica. 

"  The  Third  District  includes  seventeen  counties,  which  are  from  sixty 
to  one  hundred  and  twenty  miles  distant:  Albany,  Broome,  Cayuga, 
Columbia,  Delaware,  Greene,  Hamilton,  Jefferson,  Eensselaer,  Saratoga, 
Schenectady,  Seneca,  Tioga,  Tompkins,  Warren,  Washington,  Wayne. 

"  The  Fourth  District  includes  the  most  distant  counties,  which  are 
from  one  hundred  and  twenty  to  three  hundred  and  fifty  miles  from 
Utica  :  Allegheny,  Cattaraugus,  Chautauqua,  Chemung,  Clinton, 
Dutchess,  Erie,  Essex,  Franklin,  Genesee,  Livingston,  Monroe,  Niagara, 
Ontario,  Orange,  Orleans,  Putnam,  Queen,  Eichmond,  Eockland,  Schuy- 
ler, Steuben,  St.  Lawrence,  Suffolk,  Sullivan,  Ulster,  Westchester, 
Wyoming,  Yates. 

"  These  four  districts  include  all  the  counties  of  the  State,  except  New 
York  and  Kings,  which  have  each  hospitals  of  their  own,  and  therefore 
little  or  no  occasion  or  inducement  to  send  patients  to  Utica. 

"  The  population  of  each  o^these  districts  has  been  ascertained  and 


110 

calculated  for  each  of  the  twenty-three  years,  eighteen  hundred  and 
forty -three  to  eighteen  hundred  and  sixty-five  inclusive,  since  the  hos- 
pital was  opened.  The  number  of  patients  sent  to  the  hospital  from 
each  district  within  that  period  has  also  been  ascertained. 

''  Taking,  then,  the  sum  of  the  annual  populations  for  twenty-three 
years,  and  dividing  it  by  the  number  of  patients  sent  in  that  time,  shows 
the  proportion  of  patients  which  each  district  has  sent  out  of  its  whole 
number  of  people.  These  numbers  and  facts  are  presented  in  the  fol- 
lowing statement: 

"  For  these  twent^'-three  years — eighteen  hundred  and  forty-three  to 
eighteen  huncii'ed  and  sixty-tive — Oneida  County  sent  one  in  two  thou- 
sand seven  hundred  and  seventy-two  of  their  number  to  the  hospital. 
The  Second  District  sent  one  in  five  thousand  eight  hundred  and  twenty 
of  their  number  to  the  hospital;  the  Third  District  sent  one  in  seven 
thousand  three  hundred  and  fifty-one  of  their  number  to  the  hospital; 
the  Fourth  District  sent  one  in  eleven  thousand  five  hundred  and  thirty- 
five  of  their  number  to  the  hsopital. 

POPULATION    AND    PATIENTS    OF   DISTRICTS. 


SUMMARY. 


Districts. 


Sum  of  the  annual  population  for  twenty- j 
three  years j  2,292,643 

Patients  sent  to  the  hospital  in  twenty-three 
years 

Average  annual  population 

Average  patients  sent  to  the  hospital 

Population  to  one  patient  sent  to  the  hos 
pital  in  each  year 


827 

99,680 

36 


10,528,406 

1,809 
457,756 


5,820 


16,337,520 

2  222 

710^327 

96 

7,351 


28,146,477 

2,440 

1,223,760 
106 

11,535 


V  This  shows  a  great  disproportion  in  the  uses  made  of  the  hospital  by 
the  people  of  the  near  and  of  the  remote  counties. 

-'  Taking  a  basis  of  one  thousand  for  the  extent  of  the  enjoyment  of 
the  hospital  by  the  remotest  districts,  the  proportionate  enjoyment  of  the 
districts  will  be:  Fourth,  one  thousand;  Third,  onethousand'^five  hundred 
and  sixty-eight;  Second,  one  thousand  nine  hundred  and  eighty-one; 
First,  four  thousand  one  hundred  and  ninety-six. 

''  The  advantages  of  the  hospital  enjoyed  by  Oneida  County  have  been 
more  than  double  those  enjoj'ed  by  the  counties  next  beyond,  but  within 
sixty  miles;  they  are  nearly  threefold  those  enjoyed  by  the  counties 
which  are  from  sixty  to  one  hundred  and  twenty  miles  distant;  and  more 
than  four  times  as  great  as  those  enjoyed  by  the  people  of  the  counties 
which  are  more  than  one  hundred  and  twenty  miles  distant. 

''  It  will  not  be  supposed  that  the  insane  persons  who  needed  the  hos- 
pital care  or  treatment  in  these  districts  were  in  these  proportions.  It 
cannot  be  supposed  that  the  number  of  lunatics  in  Oneida  County  is 
twice  is  great  as  that  in  Oswego;  Fulton,  Schoharie,  Herkimer,  and  the 
counties  beyond  Oneida,  but  within  sixty  miles;  or  four  times  as  great 
as  that  in  counties  one  hundred  and  twenty  and  more  miles  from  this 
district. 

"  The  State  censuses  of  eighteen  hundjFbd  and  fifty-five  and  eighteen 


Ill 

hundred  and  sixty-five  show  the  numher  of  the  insane  in  the  several 
counties  of  New  York.  Arranging  these  in  the  districts  herein  described, 
according  to  their  distance  from  Utica,  they  were  in  proportion  to  the' 
popuhition: 

•      POPULATION    TO    ONE   LUNATIC   IN    NEW    YORK. 


DISTRICT. 

1855. 

18G5. 

First 

1,224 
1,525 
1,457 

1,788 

1,300 
1,611 
1,396 
1,904 

Second 

Third .*.'    ..'.'.*.' 

Fourth 

"  This  diversity  of  advantage  of  an  insane  hospital  enjoyed  by  the  people 
of  near  and  remote  districts  is  not  an  accident,  nor  a  peculiarity  of  New 
York  alone.  It  is  a  general  and  probably  universal  principle — a  natural 
and  necessary  law  of  nature  or  humanity;  for  in  all  other  States  whose 
hospital  records  of  patients'  residence  have  been  obtained,  the  same  law 
is  found  to  be  in  operation,  and  the  people  send  their  patients  to  these 
institutions  in  j^roportion  to  their  nearness. 

"  In  twenty-six  States,  for  various  periods  of  years,  insane  hospitals  have 
been  in  operation,  whose  doors  are  and  have  been  open  alike  to  all  of  their 
people.  The  reports  of  most  of  these  institutions  state  the  number  which 
have  been  sent  to  them  from  each  county.  From  the  others,  copies  of 
the  records  of  facts  have  been  obtained,  showing  the  number  which 
the  various  parts  of  the  States  have  contributed  to  till  the  wards  of  these 
institutions.  In  order  to  determine  the  extent  and  application  of  the 
law  of  distance  in  the  use  of  hospitals,  these  other  States  and  two  of  the 
British  Provinces  have  been  examined  and  analyzed  in  the  same  way  as 
New  York. 

"  They  have  been  divided  into  concentric  districts,  making  the  county 
in  which  the  hospital  is  situated  the  first,  and  the  contiguous  counties 
the  second  district,  and  the  others  more  distant.  The  populations  of 
these  several  districts  have  been  calculated  and  determined  for  each  of 
the  years  in  which  the  hospital  has  been  in  operation,  or  in  which  the 
records  of  the  residence  of  the  patients  were  kept  and  have  been  ob- 
tained, and  the  comparison  made  of  the  proportion  of  patients  to  popu- 
lation of  the  several  districts. 

''  It  should  be  here  stated  that,  in  making  these  concentric  circular 
divisions,  it  has  been  impossible  to  make  them  perfectly  regular,  with 
an  exactly  equal  radius  from  the  common  centre,  or  equal  distance  of 
the  inner  and  outer  boundary  from  the  hospital,  for  the  counties  are  very 
diversely  and  irregularly  shaped,  some  of  them,  as  in  Maine,  being  nearly 
one  hundred  and  fifty  miles  long.  While,  then,  a  district  may  be  stated 
to  be  within  certain  specified  distances  from  the  hospital,  circles  drawn 
upon  the  radii  would,  on  both  sides,  exclude  some  part  of  the  territory 
that  belongs  to  it,  and  include  some  that  belongs  to  its  neighbor.  Never- 
theless, these  irregularities  of  border  or  exceptions  to  the  rule  will  not 
militate  with  the  general  plan  nor  vitiate  any  calculations  made  upon  or 
deductions  made  from  this  analysis  of  the  States  and  hospital  receptions. 

"  Twenty -two  States  and  two  British  Provinces  furnish  the  conditions 


112 

requisite  for  the  purpose  of  this  report,  and  are  included  in  the  calcula- 
tions and  statements. 

POPULATION    TO    ONE   PATIENT    ANNUALLY    SENT    TO    LUNATIC    HOSPITALS. 


Maine 

New  Hampshire 

Massachusetts 

Khode  Island 

New  York 

Kew  Jersey 

Pennsylvania 

East  Pennsylvania 

"West  Pennsylvania 

Maryland 

Virginia 

Korth  Carolina 

Mississippi 

Louisiana 

Tennessee 

Kentucky 

Ohio   

Illinois  .. 
Michigan 
Missouri 
Canada 
Nova  Scotia 


"  In  all  these  States  the  privileges  of  the  hospitals  are  offered  equally 
to  the  people  of  the  counties.  Tbe  patients  of  Oneida  and  Allegany 
Counties  in  Xew  York,  of  Mercer  and  Warren  Counties  in  New  Jersey, 
of  Dauphin  and  Yenango  Counties  in  Pennsylvania,  can  enter  on  the 
same  terms,  enjoy  the  same  advantages,  and  for  the  same  price.  The 
only  difference  is  the  burden  of  cost,  care,  and  labor  of  travel  from 
their  homes  to  the  place  of  healing.  And  yet  the  actual  use  of  the  hos- 
pital by  and  the  practical  value  of  these  institutions  to  the  people  of  the 
remote  districts  have  been  only  one  fourth  as  great  in  New  Y^ork,  about 
one  third  as  great  in  New  Jersey,  and  less  than  one  third  as  great  in 
Pennsylvania  as  they  have  been  in  the  districts  near  to  them. 

"  Similar  discrepancies  in  favor  of  the  central  counties  and  against  the 
district  counties  are  seen  to  have  existed  in  all  the  other  States  whose 
record  has  been  obtained. 

EFFECT    OF    MULTIPLYING    HOSPITALS. 

"  This  principle  has  been  remarkably  manifested  whenever  and  wher- 
ever a  second  hospital  has  been  opened  in  any  State  and  placed  in  a 
district  remote  from  the  one  previously  in  operation.     The  people  who 


*  There  is  apparently  something  unexplained  in  the  record  of  one  county  in  each  of  these 
districts. 


t  Excluding  1844,  1845,  1846,  and  1847. 
t  Excluding  1861,  1862,  and  1863. 


113 

sent  a  few  patients  to  the  distant  institu^on  now  sent  many  to  the  hos- 
pital which  was  brou<;-ht  to  thoir  neighborhood.  The  number  of  luna- 
tics that  found  a  place  of  healing  was  suddenly  and  permanently 
increased. 

"  In  Massachusetts,  the  hospital  at  Worcester  was  the  only  State  insti- 
tution for  the  insane  in  the  Commonwealth  from  eighteen  hundred  and 
thirty -three  to  eighteen  hundred  and  fifty-four,  when  the  second  hospital 
was  oj^ened  in  Taunton,  Bristol  County,  for  the  southeastern  part  of  the 
State.  The  Worcester  establishment  continued  to  receive  all  the  patients 
from  the  northern,  central,  and  western  counties  until  eighteen  hundred 
and  fifty-eight,  when  the  third  hospital  was  opened  at  Northampton, 
Hampshire  County,  for  the  western  district.  In  both  of  these  districts 
there  was  a  sudden  and  large  increase  of  the  insane  whose  friends  sought 
and  used  these  new  places  of  healing  for  them.  During  the  eight  years — 
eighteen  hundred  and  forty-five  to  eighteen  hundred  and  fifty-three — 
previous  to  the  opening  of  the  Taunton  Hospital  the  people  of  Bristol 
County  had  sent  one  hundred  and  fifty-one  patients  to  Worcester,  which 
was  an  annual  average  of  one  patient  in  four  thousand  four  hundred  and 
thirty-four  inhabitants.  During  the  eight  years  after  the  hospital  was 
opened  within  their  borders  they  sent  three  hundred  and  twenty-four 
patients  to  it,  which  was  an  annual  average  of  one  patient  in  two  thou- 
sand one  hundred  and  ninety -four  people. 

"  In  the  former  period  the  people  of  Plymouth  County  sent  one  in  three 
thousand  seven  hundred  and  nineteen  of  their  niimber,  and  in  the  latter 
period  one  in  two  thousand  seven  hundred  and  seventy-four. 

<'  Barnstable,  Dukes,  and  Nantucket  Counties  sent  in  the  former  period 
one  in  four  thousand  one  hundred  and  eighteen,  and  in  the  latter  one  in 
three  thousand  five  hundred  and  seventy-three  to  the  hospitals. 

POPULATION   FOR    ONE    PATIENT     SENT   ANNUALLY   TO    THE    STATE    HOSPITALS. 


1845  to  1853. 

1854  to  1862, 

1 

^ 

cc 

hd 

hj 

m 

^ 

o 

COUNTIES. 

3 

It 

13 

&3 
2  £. 

1.1 

o 

Cti 

0  -^ 

3  ^ 

s- 

p  '-^ 

3    r*- 

p 

f^ 

.•^o 

'  f  ^5 

r  O 

ct> 

!►§ 

:   o 

i^ 

•   2 

:   c 

:    3 

:    P 

:   3 

.     CO 

Bristol        

151 

669,581 
493,215 

4,434 

324 

810,903 

2,194 

102.1 

Plymouth 

132 

3,719 

204 

565,981 

2,774 

34. 

Barnstable  ] 

Nantucket  >  

Dukes J 

104 

429,319 

4,118 

118 

421,662 

3,573 

15.2 

Totals 

387 

1,592,115 

4,111 

646 

1,798,546 

2,784 

42.9' 

"  During  the  four  years — eighteen  hundred  and  fifty-four  to  eighteen 
hundred  and  fifty-eight — the  people  of  Hampshire  County  sent  thirty- 
seven  patients  to  the  Worcester  Hospital,  which  was  an  annual  average  of 
one  in  four  thousand  and  eight  inhabitants.  In  the  four  years  after  the 
opening  of  the  third  hospital  in  their  midst,  the  same  people  sent  eighty- 


15 


114 

five  jDersons,  or  one  in  one  thousand  seven  hundred  and  eighty-seven  of 
their  number  to  its  care. 

"  Franklin  County  sent  in  the  former  period  nineteen  patients,  or  one  in 
six  thousand  five  hundred  and  seventy-four  people,  to  Worcester;  and  in 
the  latter  j^eriod  fifty-two,  or  one  in  two  thousand  four  hundred  and 
nineteen  people,  to  ]S"orthampton.  Berkshire  County  is  geographically 
fifty  miles  nearer  to  jS"ortham2)ton  than  to  Worcester.  But  a  range  of 
mountains  lies  between,  and  the  roads  are  difficult  for  travelers,  who  can 
use  only  private  conveyances,  except  the  Western  Eailroad  to  Spring- 
field, and  the  Connecticut  Eiver  Eailroad  from  Springfield  to  North- 
ampton. This  practically  reduces  the  difference  of  distance  betw^een 
the  two  hospitals  to  thirty  miles.  And  many  w^hen  once  in  the  cars  on 
the  Western  Eoad  find  it  easier  to  continue  fifty-four  miles  further  to 
Worcester,  than  to  change  cars  and  go  twenty  miles  to  Northampton, 
with  their  j^atients.  Therefore  the  increase  is  less  in  Berkshire  County 
than  in  the  others.     Nevertheless,  there  w^as  an  increase. 

<' Before  eighteen  hundred  and  fifty-eight  the  Berkshire  people  sent 
thirty-three  patients,  or  one  in  six  thousand  nine  hundred  and  thirty- 
seven  people,  yearly  to  AYorcester,  and  after  that  they  sent  to  Worcester 
and  Northampton  forty-seven  jjatients,  or  an  average  in  each  year  of  one 
in  four  thousand  seven  hundred  and  fifteen  peoj^le. 

"  To  the  towns  in  the  eastern  j^art  of  Hampden  County,  Worcester  is 
nearer  and  more  accessible  than  NorthamjDton.  Most  of  the  people 
must  necessarily  use  the  Western  Eailroad,  whether  going  to  Worcester 
or  Northampton,  and  all  must  change  cars  at  Sj^ringfield  if  they  go  to 
Northampton,  but  not  if  they  go  to  Worcester. 

"  The  people  of  Hampden  County  sent  in  the  former  period  one  in  two 
thousand  one  hundred  and  eighty-five  of  the  living  to  Worcester,  and  in 
the  latter,  one  in  one  thousand  nine  hundred  and  eighty-eight  in  each 
year. 


POPULATION     TO 


ONE     PATIENT     SENT     TO     HOSPITAL     BEFORE 
NORTHAMPTON   HOSPITAL   WAS   OPENED. 


AND      AFTER 


Western  District. 


1855  to  1858,  four  years. 

1859  to  1862,  four  years. 

Increase. 

COUNTIES. 

en- 

11 

It 

i 

w 
o 

3 

fi 

People  to  1 
patient. 

33 

19 

37 

101 

212,437 
124,916 

148,294 
220,680' 

6,437 
6,574 
4,008 

2,185 

47 

52 

85 

116 

221,640 
125,830 
151,897 
230,784 

4,715 
2,419 

1,787 
1,988 

38.6 

Franklin 

171.2 

Hampshire 

Hampden 

124.3 
9.9 

Total  Counties 

190 

706,327 

3,717 

300 

730,151 

2,433 

52.7 

"  The  peoi:»le  of  Hampshire  County  nearly  trebled  the  number  and 
proportion  of  their  patients  in  the  hospital.  The  people  of  Franklin  and 
Bristol  more  than  doubled  them,  and  the  other  counties  also  increased 


115 

them  very  greatly,  and  thus  so  many  more  of  their  hmatics  found  places 
of  healing  and  protection  when  the  hospital  was  brought  to  their  neigh- 
borhood and  within  their  reach. 

EFFECT    OF   RAILROADS    AND    OTHER    FACILITIES    OF   TRAVEL. 

"Facilities  of  travel,  navigable  rivers,  canals,  railroads,  i^ublic  high- 
ways, jHiblic  conveyances,  which  render  communication  easy  and  cheap, 
and  intercourse  familiar,  and  virtually  diminish  distance  from  the  hospital, 
increase  the  ratio  of  patients  that  are  sent  to  it.  We  therefore  find  that 
three  counties  which  are  situated  along  the  course  of  rivers,  canals, 
roads,  etc.,  leading  directly  to  the  situation  of  the  hospitals,  have  sent 
more  patients  to  these  institutions  than  other  counties  of  equal  popula- 
tion and  at  equal  distances,  but  not  favored  with  these  facilities  of  com- 
munication. Ten  counties  in  New  York  along  the  line  of  the  railroad, 
canal,  etc.,  east  and  west  of  Utica,  with  easy  means  of  travel,  sent  two 
thousand  one  hundred  and  fifty-one  patients  to  Utica,  or  one  in  seven 
thousand  two  hundred  and  sixty-six.  While  during  the  same  period  ten 
other  counties,  northeast  and  southwest  from  Utica,  with  no  easy  means 
of  communication,  sent  six  hundred  and  forty-seven  patients,  or  one  in 
eleven  thousand  nine  hundred  and  thirty-four  of  their  number  to  the 
State  Hospital.  Taking  all  these  facts  into  view,  we  have  here  indis- 
putable proof  of  the  effect  of  distance  in  diminishing  the  practical  bene- 
fits of  lunatic  hospitals  to  the  people  of  any  district.  In  all  these  States 
these  hospitals  are  as  open  and  their  advantages  as  freely  granted  to 
the  patients  from  the  most  remote  towns  as  to  those  in  their  very  neigh- 
borhood. It  is  not  hinted,  or  even  suspected,  that  the  lunatics  whose 
friends  reside  afar'  off  are  not  as  kindly,  as  faithfully,  and  as  success- 
fully treated,  and  at  as  small  a  cost,  as  those  whose  friends  are  so  near 
as  to  keep  a  watchful  vigilance  over  their  welfare. 

HOSPITALS    ARE   BETTER    KNOWN    TO    THE    NEIGHBORING   PEOPLE. 

"  The  idea  of  the  hospital  purposes  and  its  management  is  familiar  to 
those  who  live  in  its  vicinity.  They  know  its  means,  its  objects,  and 
its  administration;  they  know  the  character  of  its  officers  and  its 
attendants.  They  are  frequently  witnessing  its  operations  and  results 
in  the  many  who  are  going  to  and  returning  from  it  in  improved  or 
restored  mental  health.  Whenever  they  think  of  the  possibility  of  their 
becoming  insane,  the  idea  of  the  hospital  jn-esents  itself  to  their  minds  in 
the  same  connection  almost  as  readily  as  the  idea  of  their  own  chambers, 
their  own  physician,  and  the  tender  nursing  of  their  own  family  is  asso- 
ciated with  the  thought  of  having  a  fever  or  dysentery;  and  w^hen  any 
one  of  their  family  or  friends  become  deranged  the  hospital  occurs  to 
them  as  a  means  of  relief,  and  they  look  upon  it  as  a  resting  place  from 
their  troubles. 

"  But  this  ready  association  of  the  hospital  with  lunacy  and  this 
generous  confidence  in  its  management  diminishes  as  we  recede  from  it. 
The  people  in  the  remoter  j^laces  know  the  general  facts;  but  distance 
lends  an  obscurity  to  the  notion,  and  thus  the  character  of  the  hospital 
and  its  administration  do  not  stand  before  them  as  the  thought  of  home 
and  domestic  arrangements,  of  w^hich  they  can  cheerfully  and  trustfully 
avail  themselves  in  any  emergency.  To  them  the  hospital -seems  a 
strange  place;  perhaps  a  place  of  unkind  restraint,  or  even  of  needless 
confinement,  rather  than  a  home  of  tenderness.     Its  officers  are  to  them 


116 

strangers  rather  than  friends;  and  its  attendants,  though  good  and 
honest  persons,  are  not  as  household  comforters  and  nurses,  or  even  as 
neighbors,  whose  ready  and  affectionate  sj'mpathy  is  sure,  and  on  whom 
they  are  accustomed  to  call  in  time  of  trouble,  and  to  whom  they 
unhesitatingly  commit  the  care  of  their  disordered  and  distressed 
relatives  or  children. 

'•'  Then  the  unwillingness  to  be  far  separated  from  their  suffering  or 
weakened  friends  operates  with  many.  This  is,  indeed,  a  mere  feeling 
or  sentiment ;  but  it  is  converted  into  practical  facts,  and  retains  some 
at  home  who  would  otherwise  be  sent  to  and  cured  in  a  hospital  if  it 
were  nearer  to  them.  The  State  Lunatic  Hospital,  when  it  is  used,  is  no 
better  to  the  people  of  Oneida  than  to  those  of  Cattaraugus  and  Clinton; 
but  so  long  as  a  jDortion  of  the  people  of  the  remote  counties  do  not  feel 
so  their  insane  friends  are  not  sent  there. 

"  The  difficulties  and  expense  of  sending  lunatics  over  long  distances, 
or  unfrequented  and  indirect  roads,  or  by  private  conveyances,  are  per- 
haps the  most  effectual  obstacle  in  the  way,  and  more  than  any  other 
diminish  the  number  of  patients  with  the  increase  of  miles  that  separate 
them  from  the  hospital. 

"  For  these  reasons  the  towns  in  the  neighborhood  of  the  public  hos- 
pital in  this  State  have  enjoyed  more  than  four  times  as  much  of  its 
benefits  as  the  remote  towns;  and  all  the  other  hospitals  mentioned  in 
this  article  have  been  compelled  to  confer  their  blessings  in  a  similar 
and  some  of  them  in  a  much  greater  disproportion  upon  the  people  of 
the  neighboring  than  upon  those  of  the  distant  districts  of  the  State  to 
which  they  respectively  belong. 

"  We  think  we  have  here  presented  facts  enough  to  establish  it  as  a 
general  principle  that  the  advantages  of  any  public  lunatic  hospital, 
however  freely  and  equally  they  may  be  offered  to  all  the  people  of  an}^ 
State,  are  yet  to  a  certain  degree  local  in  their  operation,  and  are  enjoyed 
by  people  and.  communities  to  an  extent  in  proportion  to  their  nearness 
to  or  distance  from  it. 

'•  Whenever  and  wherever  the  same  causes  exist  the  same  effects  must 
be  produced,  and  any  hospital  that  may  be  hereafter  established  must 
be  subject  to  the  same  law.  This  law  of  nearness,  inviting  and  increas- 
ing the  patients,  and  of  distance,  preventing  and  diminishing  the  number 
in  hospital,  is  our  very  nature,  and  must  operate  in  the  future  as  well  as 
the  past.  The  people  will  be  influenced  by  the  same  motives  in  time  to 
come,  as  they  have  been  in  the  years  that  have  gone  by." 

OBSERVATIOXS    ON    FOREGOING    TOPICS. 

Thus  we  are  shown,  by  the  interesting  paper  prepared  with  the  great- 
est care  by  this  able  and  accurate  observer,  that  insane  asylums  dispense 
their  blessings  almost  in  proportion  to  their  convenience  to  the  people. 
We  also  learn  from  other  sources  that  the  proportion  of  cures  from  the 
nearer  counties  is  much  greater  than  those  in  the  second  radius  of  dis- 
tance, and  so  on  with  corresj^onding  ratio  to  the  third  and  fourth.  This 
is  what  we  might  naturally  expect,  as  those  who  live  near  the  hospital 
would  be  sent  to  it  for  treatment  at  the  earliest  j^eriod  after  the  attack, 
while  those  living  at  the  greatest  distance  would  defer  the  separation 
from  the  afflicted  member  of  the  family  to  the  latest  moment,  and  too 
often  till,  all  hope  of  relief  has  j^assed  away. 

It  is  interesting  to  notice  in  this  connection  that  since  the  publication 
of  Doctor  Jarvis'  paper  the  State  of  i^ew  York  has  inaugurated  an 


117 

entirely  new'  policy,  and  we  are  informed  by  Doctor  Charles  S.  Hoyt, 
Secretary  of  tlie  Board  of  State  Commissioners  of  Public  Charities,  in  a 
letter  recently  received  from  that  gentleman,  that  it  has  been  determined 
to  bring  every  insane  person  within  its  borders  under  the  supervision  of 
its  otticers;  and  that  bills  have  already  been  passed  autlioriziug  tho 
establishment  of  first  class  asylums  for  the  accommodation,  care,  and 
treatment  of  all  the  insane  in  the  State. 

The  following  brief  description  of  these  asylums,  with  amount  of 
appropriation  for  each,  as  well  as  their  location,  will  best  convey  an 
idea  of  the  noble  work  that  has  been  undertaken,  and  may  serve  to 
guide  us  in  the  judicious  location  of  our  new  asylum: 

THE    NEW    YORK    STATE   LUNATIC   ASYLUM^    AT    UTICA. 

This  asylum,  the  only  State  institution  for  the  insane  fully  completed, 
was  organized  by  the  Legislature  in  eighteen  hundred  and  forty-two, 
and  opened  for  patients  in  eighteen  hundred  and  forty-three. 

The  buildings  consist  of  a  central  edifice,  two  front  and  two  rear 
wings,  a  cross  wing,  additional  wings,  and  outbuildings.  The  front  and 
centre  are  constructed  of  stone,  and  the  other  portions  mainly  of  brick. 
The  central  building  is  four  stories  in  height  above  the  basement,  and 
one  hundred  and  twenty  by  seventy-six  feet  on  the  ground.  The  front 
wings  are  three  stories  high,  and  each  has  an  area  of  two  hundred  and 
fifteen  by  thirty-five  feet.  The  rear  wings  are  of  the  same  height,  two 
hundred  and  fifty  feet  each  in  length,  and  thirty  feet  in  width.  The 
cross  wing  is  two  stories  high,  twenty -five  feet  wide,  and  three  hundred 
and  fifty  feet  long;  One  of  the  additional  wings  is  two,  and  the  others 
are  one  story  in  height.  The  former  has  an  area  of  eighty-five  by 
twenty-five  feet,  and  the  latter  one  hundred  and  sixty-three  by  thirty- 
four  feet.  The  entire  edifice  presents  a  front  of  five  hundred  and  fifty, 
and  the  flanks  a  depth  of  two  hundred  and  fifty  feet.  It  is  heated  by 
steam,  lighted  by  gas,  and  ventilated  in  the  most  approved  manner. 
The  outbuildings  are  a  mortuary,  bakery,  coal  house,  work  shops,  boiler 
and  engnie  house,  containing  also  the  fans  for  ventilation,  and  drying 
and  ironing  rooms,  wash  house,  farm  buildings,  carriage  house,  barns, 
ice  house,  etc. 

The  asylum,  as  first  erected,  and  until  eighteen  hundred  and  fifty-two, 
had  room  for  only  four  hundred  and  fifty  (450)  patients.  Since  that 
date,  the  original  buildings  have  been  remodeled,  the  additional  wings 
erected,  and  the  cross  wing  adapted  to  the  insane,  by  which  the  institu- 
tion has  been  made  to  accommodate  six  hundred  (600)  patients.  It 
also  furnishes  apartments  for  the  resident  officers  and  necessary  attend- 
ants and  employes.  Cost — six  hundred  and  sixty-one  thousand  and 
sixty-five  dollars  and  fifty-eight  cents. 

THE  WILLARD  ASYLUM  FOR  THE  INSANE,  AT  OVID. 

This  institution,  designed  for  the  chronic  pauper  insane,  heretofore 
provided  for  in  the  county  poorhouscs,  and  for  those  who  may  be  here- 
after discharged  from  the  State  Asylum  at  Utica  as  incurable,  was 
established  by  an  Act  of  the  Legislature,  passed  April  fifth,  eighteen 
hundred  and  sixty-five.  The  site,  known  as  the  "  State  Agricultural 
Farm,"  contains  four  hundred  and  seventy-five  (475)  'acres,  near  the 
Tillage  of  Ovid,  on  the  east  shore  of  Seneca  Lake.  The  erection  of  the 
building  was  commenced  in  the  Spring  of  eighteen  hundred  and  sixty- 


118 

six,  and  it  was  so  fur  advanced  as  to  be  opened  for  patients  in  October, 
eighteen  hundred  and  sixty-nine. 

"The  main  asylum  building  is  situated^near  the  lake.  The  plan  of  this 
edifice  comprises  a  centrarbuilding  for  the  Superintendaut's  residence 
and  offices,  and  a  north  and  a  south  wing,  Avith  extensions  from  the 
extremities  of  these  to  the  rear,  for  patients.  It  is  a  plain,  substantial, 
three  story  brick  structure,  well  planned  and  arranged,  and  furnished 
with  the  appliances  and  conveniences  requisite  for  its  purposes. 

In  addition  to  the  main  asylum,  there  is  the  '•  Agricultural  College 
Building,"  on  the  premises  when  acquired  by  the  State,  and  now  known 
as  the  "Branch."  This  building,  situated  about  one  mile  from  the  main 
edifice,  was  remodeled  and  fitted  up  the  past  year,  and  occupied  by' 
female  patients  in  November  last.  It  is  a  plain,  substantial  brick  struc- 
ture, in  good  preservation,  and  appears  to  be  well  adapted  for  the  j^ur- 
poses  to  which  it  is  applied.  The  Trustees  estimate  -it  to  have  cost  one 
hundred  and  fifty  thousand  dollars. 

The  cost  of  the  buildings  now  in  use  for  the  insane,  and  the  Trustees' 
estimated  cost  for  the  completion  of  those  in  process  of  erection  and 
proposed,-  is  shown  by  the  following  statement: 


Cost  of  the  main  asylum  and  branch  in  use,  including  fur-, 

niture,  out  buildings,  etc.  (as  stated  above) j    8446,998  44 

For  the  completion  of  the  south  wing,  including  the  amount' 

already  expended  (estimated) 81,728  67 

For  the  extension  to  the  north  wing,  erecting  a  single  group  j 

of  detached  buildings,  furniture,  fences,  further  Avater-sup-|    . 

ply,  etc.  (estimated) 200,000  00 


Total. 


$728,727  11 


The  completion  of  the  buildings  as  proposed  will  give  accommodations 
for  the  insane  as  follows:  in  the  main  asylum,  five  hundred  (500);  the 
''branch,"  two  hundred  (200);  single  group  of  cottages,  two  hundred 
(200);  total,  nine  hundred  (900)  patients. 

The  Trustees  of  this  asylum  express  the  opinion  that  its  capacity 
may  be  very  properly  extended  by  the  erection  of  additional  groups  of 
detached  buildings  similar  to  the  one  proposed  at  difterent  points  on  the 
farm,  so  as  to  include  nearly  if  not  all  the  chronic  pauper  insane  of  the 
State  not  suitably  provided  for  otherwise.  In  the  judgment  of  these 
officers  this  would  prove  economical,  by  lessening  the  cost  of  the  build- 
ings per  capita,  and  utilizing  the  labor  of  the  insane,  and  at  the  same 
time  secure  to  them  under  a  single  responsible  direction  and  control, 
better  treatment  and  care.  This  subject  is  one  of  such  great  public 
importance,  not  only  as  atfecting  the  insane,  but  as  to  the  cost  of  pro- 
viding for  their  maintenance,  that  the  Board  deems  it  proper  to  present 
it  to  the  attention  of  the  Legislature. 

THE    HUDSON    RIVER    STATE    HOSPITAL    FOR    THE    IXSAXE 

Was  established  by  the  Legislature  ]\Iarch  sixteenth,  eighteen  hundred 
and  sixty-seven.  The  site,  previously  selected  b}^  Commissioners  ap- 
pointed by  the  Governor,  contains  three  hundred  (300)  acres.     Its  loca- 


119 

tion  is  on  the*  east  bank  of  the  Hudson  Eiver,  two  miles  north  of  the 
City  of  Poughkeepsie. 

The  plan  of  this  hospital  comprises  a  central  edifice  for  administrative 
purposes,  and  a  north  and  a  south  wing,  composed  of  four  sections  each, 
for  patients.  It  also  includes  a  chapel,  general  kitchen,  boiler  and  engine 
house,  workshops,  gas  house,  etc.,  to  be  situated  at  the  rear  of  the  cen- 
tral structure. 

The  erection  of  the  building  was  commenced  in  September,  eighteen 
hundred  and  sixty-seven.  The  three  extreme  sections  of  the  south  wing 
are  nearly  finished  and  partly  furnished,  and  it  is  stated,  if  funds  were 
provided,  could  be  soon  ready  for  patients.  The  boiler  and  engine  house 
are  built  and  two  boilers  set;  the  foundations  for  the  four  remaining 
boilers  required  for  the  entire  building  are  laid;  the  great  chimney,  con- 
taining flues  for  the  boilers,  kitchen  range,  bake  shop,  gas  retorts,  and 
central  ventilating  shaft,  is  also  built;  the  underground  air  duct  is  made, 
and  the  main  sewer  laid  from  the  chimney  to  the  river.  The  reser- 
voir for  the  fall  capacity  of  the  hospital  is  two  thirds  completed,  and 
the  arrangements  for  water  are  said  to  be  adequate  for  its  present 
purposes. 

The  hospital  is  being  constructed  of  North  Eiver  brick,  with  a  better 
quality  for  face  work.  The  window  heads  are  of  Ohio  stone,  with  blue 
stone  introduced  to  increase  the  artistic  effect.  The  centre  building  and 
a  part  of  two  sections  of  each  wing  will  be  three,  and  the  residue  two 
stories  in  height. 

The  portions  of  the  building  erected  will  accommodate  one  hundred 
and  twenty  (120)  patients,  and  when  the  hospital  is  comj^leted  according 
to  the  plans  adoj)ted  it  will  furnish  room  for  four  hundred  (400). 

The  Medical  Superintendent  reports  that  the  estimated  cost  of  the 
building  when  the  plans  were  adopted  was  six  hundred  and  sixty-six 
thousand  dollars;  but  in  the  event  of  the  continuance  of  the  inflated 
prices  for  materials  and  labor  heretofore  paid  it  will  cost,  when  com- 
pleted according  to  these  plans,  twelve  hundred  thousand  dollars.  It  is 
stated,  however,  by  this  officer,  that  this  estimate  may  be  modified  by 
the  gradual  decrease  in  prices  now  taking  place,  and  the  advantages  to 
be  derived  from  the  increase  of  power  from  the  boilers,  in  the  use  of  the 
machinery,  etc.,  but  that  no  great  reduction  can  be  anticipated.  The 
institution  is  designed  for  the  treatment  of  cases  of  acute  insanity,  and 
the  building  is  being  constructed  with  the  adaj)tations  and  appointments 
necessary  to  carry  out  its  objects. 

THE   BUFFALO    STATE   ASYLUM    FOR   THE  INSANE 

"Was  organized  under  chapter  three  hundred  and  seventy-eight,  laws 
of  eighteen  hundred  and  seventy.  The  site,  previously  selected  by  desig- 
nated Commissioners,  consists  of  two  hundred  (200)  acres,  situated  near 
Buffalo,  and  was  presented  by  that  city  to  the  State. 

The  Managers  report  that  the  ground  plan  of  the  building  has  been 
adopted,  and  that  the  plan  of  the  elevation  will  probably  be  soon  ap- 
proved, and  the  work  of  erection  commenced. 

The  Board  had  expected  information  as  to  the  estimated  cost  of  the 
building  from  the  Managers,  but  it  has  not  been  received.  We  learn  that 
it  is  to  be  constructed  of  brick,  with  arrangements  for  the  treatment  of 
cases  of  acute  insanity,  and  with  capacity  for  the  accommodation  of  five 
hundred  (500)  patients.  The  general  estimate  of  superintendents  of  in- 
sane asylums  for  the  erection  of  plain,  substantial  buildings  of   such 


120 

character,  and  appropriately  furnishing  the  same,  at  the  present  prices 
for  material  and  labor,  is  one  thousand  six  hundred  dollars  per  inmate. 
On  this  estimate  it  will  cost,  when  completed,  eight  hundred  thousand 
dollars. 

The  following  statement  shows  the  capacity  and  cost  of  the  State 
Asylums  for  the  insane  in  use,  and  the  estimated  capacity  and  cost  of 
those  in  process  of  erection,  or  for  which  appropriations  have  been  made, 
when  completed  according  to  the  several  plans  adopted,  as  hereinbefore 
referred  to: 


1 

NAMES  OF  ASYLUMS.                                 Capacity. 

Cost   of  the 
buildings. 

The  New  York  State  Lunatic  Asjdum  at  Utica. 

The  Willard  Asylum  for  the  Insane  at  Ovid.... 

The    Hudson    Eiver    State    Hospital  for    the 

Insane  at  Poughkeepsie 

600 
900 

400 

500 

200 

$661,065  58 
728,727  11 

1,200,000  00 

800,000  00 
360  000  00 

The  Buffalo  State  Asylum  for  the  Insane  at 
Buffalo 

The  New  York  State  Homoeopathic  Asylum  for 
the  Insane  at  Middleton 

Total 

2,600 

$3,749,792  69 

In  conclusion,  the  Board  deems  it  proper  to  submit  a  general  view  of 
the  present  number  of  the  insane  in  custody,  of  their  condition  in  res- 
pect to  recovery,  of  the  present  provision  made  for  them,  and  the 
requirements  for  the  future. 

It  will  be  observed  that  there  were  at  the  close  of  the  first  year,  four 
thousand  four  hundred  and  eighty-four  (4,484)  insane  persons  in  public 
institutions.  Of  these,  nine  hundred  and  twenty-five  (925)  were  in  the 
State  Asylums,  and  one  hundred  and  forty-eight  (148)  in  incorporated 
institutions  receiving  State  aid.  The  Counties  of  New  York  and  Kings 
contained  one  thousand  nine  hundred  and  sixtj'-seven  (1,967);  and  there 
were  in  the  County  Poorhouses  and  City  and  County  Asylums  one 
thousand  four  hundred  and  forty-four  (1,444).  Thus  we  see  that  the 
State  of  New  York  has  not  only  determined  to  provide  asylums  for  the 
reception  of  all  of  her  insane  population,  but  has  wisel}'  chosen  locations 
in  different  jDortions  of  the  State,  that  they  may  be  easily  accessible  to 
all  of  her  citizens  who  may  be  so  unfortunate  as  to  require  their  healing 
influences;  though  while  we  commend  the  generous  liberality  and  muni- 
ficent appropriations  that  distinguish  this  noble  act  of  humanity,  we 
cannot  advise  our  legislators  to  follow  her  example  in  all  respects.  In 
the  enlightened  policy  of  providing  suitable  hospitals  for  all  who  require 
their  use,  we  most  heartily  and  unequivocally  concur;  but  we  cannot 
see  the  necessity  of  such  lavish  expenditure  in  building  palacial  resi- 
dences for  a  class  of  persons  who  can  neither  appreciate  the  magnifi- 
cence of  the  edifice,  nor  pay  for  the  luxury.  The  Poughkeepsie  Asylum, 
it  appears,  will  cost  three  thousand  dollars  for  each  patient  to  be  accom- 
modated; which,  according  to  our  view,  is  at  least  twice  as  much  as  any 
State  institution  should  cost  under  any  circumstances;  and  for  buildings 
alone,  we  are  satisfied  that  one  thousand  dollars  ($1,000)  per  patient  is 


121 

enough.  It  is  true  that  all  asylums  of  this  class  should  present  an 
attractive  and  cheerful  appearance,  its  architectural  proportions  should 
be  in  good  taste,  plain,  neat,  and  substantial;  but  all  expenditures  simply 
for  ornamentation  should  be  scrupulously  avoided,  otherwise  charity 
may  be  crippled  at  the  expense  of  pride  and  vanity. 

But  this  is  a  digression  from  the  subject  under  discussion.  We  have 
desired  to  show,  and  trust  we  have  succeeded,  that  asylums  are  intended 
for  the  use  of  the  people,  and  to  be  most  useful  they  must  be  accessible. 
This  being  admitted,  it  will  be  easy  to  conclude  that  our  next  hospital 
for  the  insane  should  be  located  somewhere  on  or  near  the  Bay  of  San 
Francisco,  and  withm  easy  reach  of  that  city.  At  what  particular  lo- 
cality, must  necessarily  depend  on  many  important  circumstances  and 
indisj^ensable  conditions;  an(,l  that  the  commission  to  which  this  respon- 
sible duty  should  be  confided  may  not,  from  inadvertance,  overlook  or 
neglect  any  of  them,  we  append  the  following  suggestions  from  the  As- 
sociation of  Medical  Superintendents  of  American  Institutions  for  the 
Insane,  and  of  the  English  and  Scotch  Boards  of  Commissioners  in  Lu- 
nacy, who,  from  their  great  ability  and  long  experience,  would  not  be 
likely  to  make  unnecessary  recommendations  on  the  one  hand  nor  over- 
look important  matters  on  the  other. 

PROPOSITIONS    RELATIVE    TO    THE    STRUCTURE   AND    ARRANGEMENT    OF   AMERI- 
CAN   INSTITUTIONS    FOR    THE   INSANE,    1853. 

I.  Every  hospital  for  the  insane  should  be  in  the  country,  not  within 
less  than  two  miles  of  a  large  town,  and  easily  accessible  at  all  seasons. 

II.  No  hospital  for  the  insane,  however  limited  its  capacity,  should 
have  less  than  fifty  acres  of  land  devoted  to  gardens  and  pleasure  grounds 
for  its  patients.  At  least  one  hundred  acres  should  be  possessed  by  every 
Slate  hospital  or  other  institution  for  two  hundred  patients — to  which 
number  these  propositions  apply,  unless  otherwise  mentioned. 

III.  Means  should  be  provided  to  raise  ten  thousand  gallons  of  water, 
daily,  to  reservoirs  that  will  supply  the  highest  parts  of  the  building. 

lY.  Ko  hospital  for  the  insane  should  be  built  without  the  plan  having 
been  first  submitted  to  some  physician  or  physicians  who  have  had  the 
charge  of  a  similar  establishment,  or  are  practically  acquainted  with  all 
the  details  of  their  arrangements,  and  received  his  or  their  full  appro- 
bation. 

Y.  The  highest  number  that  can  with  propriety  be  treated  in  one 
building  is  two  hundred  and  fifty,  while  two  hundred  is  a  preferable 
maximum. 

YI.  All  such  buildings  should  be  constructed  of  stone  or  brick,  have 
slate  or  metallic  roofs,  and,  as  far  as  possible,  be  made  secure  from  acci- 
dents by  fire. 

YII.  Every  hospital  having  provision  for  two  hundred  or  more 
patients  should  have  in  it  at  least  eight  distinct  wards  for  each  sex — ■ 
making  sixteen  classes  in  the  entire  establishment. 

YIII.  Each  ward  should  have  in  it  a  parlor,  a  corridor,  single  lodging 
rooms  for  patients,  an  associated  dormitory,  communicating  with  a 
chamber  for  two  attendants,  a  clothes  room,  a  bath  room,  a  water  closet, 
a  dining  room,  a  dumb  waiter,  and  a  speaking  tube  leading  to  the  kitchen 
or  other  central  part  of  the  building. 

IX.  No  apartments  should  be  provided  for  the  confinement  of  patients, 
or  as  their  lodging  rooms,  that  are  not  entirely  above  ground. 

16 


122 

X.  No  class  of  rooms  should  ever  be  constructed  without  some  kind 
of  window  in  each,  communicating  directly  with  the  external  atmosphere. 

XI.  No  chamber  for  the  use  of  a  single  patient  should  ever  be  less 
than  eight  by  ten  feet,  nor  should  the  ceiling  of  any  story  occupied  loy 
patients  be  less  than  twelve  feet  in  height. 

XII.  The  floors  of  patients'  apartments  should  always  be  of  wood. 

XIII.  The  stairways  should  always  be  of  iron,  stone,  or  other  inde- 
structible material,  ample  in  size  and  number,  and  easy  of  ascent,  to 
afford  convenient  egress  in  case  of  accident  from  fire. 

XIV.  A  large  hospital  should  consist  of  a  main  central  building  with 
wings. 

XV.  The  main  central  building  should  contain  the  offices,  receiving 
rooms  for  company,  and  apartments  entirely  private  for  the  Superin- 
tending Ph^'sician  and  his  family,  in  case  that  officer  resides  in  the 
hospital  building; 

XVI.  The  wings  should  be  so  arranged  that  if  rooms  are  placed  at 
both  sides  of  a  corridor  the  corridors  should  be  furnished  at  both  ends 
with  movable  glazed  sashes  for  the  free  admission  of  both  light  and  air. 

XVII.  The  lighting  should  be  by  gas,  on  account  of  its  convenience, 
cleanliness,  safety,  and  economy. 

XVIII.  The  apartments  for  washing  clothing,  etc.,  should  be  detached 
from  the  hos2:)ital  building. 

XIX.  The  drainage  should  be  underground,  and  all  the  inlets  to  the 
sewers  should  be  properly  secured  to  prevent  offensive  emanations. 

XX.  All  hospitals  should  be  warmed  by  passing  an  abundance  of  pure 
fresh  air  from  the  external  atmosphere  over  pipes  or  plates,  containing 
steam  under  low  pressure,  or  hot  water,  the  temperature  of  which  at 
the  boiler  does  not  exceed  two  hundred  and  twelve  degrees  Fahrenheit, 
and  placed  in  the  basement  or  cellar  of  the  building  to  be  heated. 

XXI.  A  complete  system  of  forced  ventilation  in  connection  with  the 
heating  is  indispensable  to  give  purity  to  the  air  of  a  hospital  for  the 
insane,  and  no  exj^ense  that  is  required  to  effect  this  object  thoroughly 
can  be  deemed  either  misplaced  or  injudicious. 

XXII.  The  boilers  for  generating  steam  for  warming  the  building 
should  be  in  a  detached  structure,  connected  with  which  may  be  the 
engine  for  pumping  water,  driving  the  washing  apparatus,  and  other 
machinery. 

XXIII.  All  water  closets  should,  as  far  as  possible,  be  made  of  inde- 
structible materials,  be  simple  in  their  ari*angement,  and  have  a  strong 
downward  ventilation  connected  with  them. 

XXIV.  The  floors  of  bath  rooms,  water  closets,  and  basement  stories 
should,  as  far  as  possible,  be  made  of  materials  that  will  not  absorb 
moisture. 

XXV.  The  wards  for  the  most  excited  class  should  be  constructed 
with  rooms  on  but  one  side  of  a  corridor,  not  less  than  ten  feet  wide,  the 
external  windows  of  which  should  be  large,  and  have  pleasant  views 
from  them. 

XXVI.  Whenever  practicable,  the  pleasure  grounds  of  a  hosj^ital  for 
the  insane  should  be  surrounded  by  a  substantial  wall,  so  placed  as  not 
to  be  unpleasantly  visible  from  the  building. 

Additional  Declarations,  1866. 

The  following  comprehensive  resolutions  were  proposed  by  Dr. 
Nichols,  of  the  Government  Hospital  for  the  Insane  at  Washington,  and 


123 

adopted  by  the  Convention  of  Medical  ^perintendents  of  American 
Institutions  for  the  Insane,  in  eighteen  hundred  and  sixty-six,  and  em- 
phatically reaffirmed  in  eighteen  hundred  and  sixty-seven.  They  com- 
prise a  full  and  clear  declaration  of  sound  principles,  tested  by  expe- 
rience : 

1.  The  large  States  should  be  divided  into  geographical  districts  of 
such  size  that  a  hospital,  situated  at  or  near  the  centre  of  each  district, 
will  be  practically  accessible  to  all  the  people  living  within  its  boun- 
daries, and  available  for  their  benefit  in  case  of  mental  disorder. 

2.  All  State,  county,  and  city  hospitals  for  the  insane  should  receive 
all  persons  belonging  to  the  vicinage  designed  to  be  accommodated  by 
each  hospital,  who  are  affected  with  insanity  proper,  whatever  may  be 
the  form  or  nature  of  the  bodily  disease  accompanying  the  mental 
disorder. 

3.  All  hospitals  for  the  insane  should  be  constructed,  organized,  and 
-managed  substantially  in  accordance  .with  the  propositions  adopted  by 
the  association  in  eighteen  hundred  and  fifty-one  and  eighteen  hundred 
and  fifty-two,  and  still  in  force. 

4.  The  facilities  of  classification  or  ward  separation  possessed  by  each 
institution  should  equal  the  requirements  of  the  different  conditions  of 
the  several  classes  received  by  such  institution,  whether  these  different 
conditions  are  mental  or  physical  in  their  character. 

5.  The  enlargement  of  a  city,  county,  or  State  institution  for  the 
insane,  which,  in  the  extent  and  character  of  the  district  in  which  it  is 
situated,  is  conveniently  accessible  to  all  the  people  of  such  district,  may 
properly  be  carried,  as  required,  to  the  extent  of  accommodating  six 
hundred  patients,  embracing  the  usual  proportions  of  curable  and  incur- 
able insane  in  a  particular  community. 

Besolutions  offered  in  the  same  Assoc^ition  in  1870. 

Besolved,  That  this  Association  reaffirm  in  the  most  emphatic  manner 
its  former  declarations  in  regard  to  the  construction  and  organization  of 
hospitals  for  the  insane;  and  it  would  take  the  present  occasion  to  add 
that  at  no  time  since  these  declarations  were  originally  made  has  any- 
thing been  said  or  done  to  change  in  any  respect  its  frequently  expressed 
and  unequivocal  convictions  on  the  following  points,  derived  as  they 
have  been,  from  the  patient,  varied,  and  long  continued  observations  of 
most  of  its  members: 

Fii-st — That  a  very  large  majority  of  those  suffering  from  mental  dis- 
ease can  nowhere  else  be  as  well  or  as  successfully  cared  for  for  the 
cure  of  their  maladies,  or  be  made  so  comfortable,  if  not  curable,  with 
equal  protection  to  the  patients  and  the  community,  as  in  well  arranged 
hospitals  specially  provided  for  the  treatment  of  the  insane. 

Second — That  neither  humanity,  economy,  or  expediency  can  make  it 
desirable  that  the  care  of  the  recent  and  chronic  insane  should  bo  in 
separate  institutions. 

Third — That  these  institutions,  especially  if  provided  at  the  public 
cost,  should  always  be  of  a  plain  but  substantial  character;  and,  while 
characterized  by  good  taste  and  furnished  with  everything  essential  to 
comfort,  health,  and  successful  treatment  of  the  patients,  should  avoid 
all  extravagant  embellishments  and  every  unnecessary  expenditure. 

Fourth — That  no  expense  that  is  required  to  provide  just  as  many 
of  these  hospitals  as  may  be  necessary  to  give  the  most  enlightened 


124 

care  to  their  insane  can  properly  be  regarded  as  either  unwise,  inexpe- 
dient, or  beyond  the  means  of  any  one  of  the  United  States. 

These  resolutions  came  before  the  Association  in  eighteen  hundred 
and  seventy-one,  and  were  unanimously  adoj^ted,  the  following  Superin- 
tendents voting  upon  the  question: 

Yeas — Doctors  Kny,  Butler,  Kirkbride,  McDill,  Shew,  AYalker,  Hughes, 
Parsons,  Landor,  Reidle,  Compton,  Gundry,  Clopton,  Grissom,  Lewis, 
Bancroft,  Curwen,  Evarts,  Dickson,  Eoy,  Gray,  and  Eead. 

Nays — None. 

In  the  discussion  upon  their  adoption,  Doctor  Eay  used  this  language: 

"Mr.  President:  I  feel  very  much  as  Mr.  Webster  did  on  one  occasion 
when  called  upon,  as  he  said,  to  reaffirm  an  ordinance  of  nature.  The 
opinions  of  the  Association  on  certain  points  have  been  so  well  fixed  for 
many  years  that  I  supposed  they  would  never  be  altered;  that  they 
were  correct  from  the  very  nature  of  things.  I  am  not  clear  now  about 
the  necessity  of  bringing  up  again  the  subject  matter  of  these  resolu- 
tions. It  does  seem  to  me  like  reaffirming  the  laws  of  nature.  The 
questions  implied  in  these  resolutions  you  are  aware  have  come  up  at 
various  times  before  the  Association,  ancl  have  been  very  thoroughly  dis- 
cussed. It  seems  to  me  we  have  discussed  them  until  they  are  thread- 
bare.    For  this  reason  I  do  not  feel  like  s^jcaking  uj^on  them  at  present." 

In  reply  to  a  question  asked  by  Doctor  Cook,  Doctor  Kirkbride  made 
these  remarks: 

"  Speaking  for  myself,  ^  should  say,  without  any  hesitation  whatever, 
that  I  do  mean,  as  the  fourth  resolution  declares,  tliat  every  State  should 
provide  enough  institutions  to  accommodate  all  the  insane  within  its 
borders.  It  is  my  firm  conviction  that  the  poorest  State  in  this  country 
is  perfectly  able  to  provide  just  as  many  hospitals  as  are  necessary.  I 
do  not  believe  any  Government  has  the  right  to  say  to  one  family,  '  We 
will  take  care  of  your  afflicted  one,'  and  say  to  another,  ^  We  will  not 
take  care  of  yours,'  simply  because  one  is  a  more  recent  case  than  the 
other.  If  we  undertake  to  provide  for  a  part  of  the  insane,  we  are 
bound  to  provide  for  all.  One  family  has  just  as  good  a  right  to  claim 
the  bounty  of  the  State  as  another." 

Doctor  Cook — "You  would  not  exclude  chronic  cases?" 

Doctor  Kirkbride — "  I  certainly  would  not." 

ENGLISH    LUNACY    COMMISSIONERS    ON    SITES,    CONSTRUCTION,    ETC. 

[Snggeptions  and  Instructions  in  Keference  to  (1)  Sites,  (2)  Construction  and  Arrangement 
of  Buildings,  (:})  Plans  of  Lunatic  Asylums,  by  the  Commissioners  in  Lunacy  for 
England  and  AVales.] 

No.  1 — Sites. — General. 

1.  The  site  of  an  asylum  should  be  of  a  perfectly  healthy  character, 
and  offer  facilities  for  obtaining  a  complete  system  of  drainage.  A 
chalky,  gravelly,  or  rocky  subsoil  is  most  desirable;  but  if  a  clayey  sub- 
soil only  can  be  obtained,  an  elevated  position  is  indispensable. 

It  should  not  be  near  to  any  nuisances,  such  as  steam  engines,  shafts 


125 

of  mines,  noisy  trades,  or  offensive  manufactures;  neither  should  it  be 
surrounded,  or  overlooked,  or  intersected,  by  public  roads  or  footpaths. 

Froportion  of  Land. 

2.  The  land  belonging  to  the  asylum  should,  when  practica])le,  be  in 
proportion  of  not  less  than  one  acre  to  four  patients,  so  as  to  afford 
ample  means  for  agricultural  employment,  exercise,  and  recreation;  and 
should  be  so  situated  as  to  offer  facilities  for  any  extension  which  may 
become  necessary  at  a  future  period. 

Form  of  Ground. 

3.  The  site  of  the  building  should  be  elevated,  as  respects  the  sur- 
rounding country,  and  (if  to  be  obtained)  undulating  in  its  surface,  and 
cheerful  in  its  j^osition,  and  having  a  fall  to  the  south. 

Position  and  Aspect  of  Budding. 

4.  The  building  should  be  placed  near  the  northern  boundary  of  the 
land;  and  it  is  important  that  the  site  should  afford  a  j^lateau  oi"  sufficient 
extent  for  the  structure,  and  for  ready  access  from  the  north;  the  whole 
of  the  southern  portion  of  the  land  being  available  for  the  undisturbed 
use  of  the  jDatients. 

Zocality. 

% 

5.  The  asylum  should  be  as  central  as  possible  to  the  mass  of  popu- 
lation in  the  country  or  district  for  which  it  is  to  be  erected,  and  should 
be  convenient  \^th  respect  to  its  easy  access  by  public  conveyance  iu 
order  to  facilitate  the  visits  of  friends  and  the  supply  of  stores. 

Supply  and  Quality  of  Water. 

6.  It  is  of  the  utmost  importance  that  there  should  be  a  constant  and 
ample  supply  of  good  water,  of  which  a  careful  analysis  should  be  made 
with  a  view  of  determining  the  proper  materials  for  pi2)es  and  reservoirs, 
and  also  to  ascertain  its  titness  for  the  purposes  of  drinking  and  wash- 
ing. The  quantity,  exclusive  of  rain  water,  should  at  the  dryest  season 
be  not  less  than  twenty-five  gallons  i)er  patient  per  diem,  and  the  amount 
should  be  accurately  gauged. 

No.  2. — Construction  and  Arrangement  of  Buildings, — General  Form. 

1.  The  general  form  of  an  asylum  should  be  such  as  to  afford  an  unin- 
terrupted view  of  the  surrounding  country,  and  the  free  access  of  sun 
and  air,  and  be  so  arranged  as  to  give  the  principal  day  rooms  on  the 
lowest  and  middle  stories  a  southern  or  southeastern  aspect. 

Entrance  and  Offices  to  the  North. 

2.  There  should  be  no  road  of  approach  or  public  entrance  on  the 
south  side  of  the  asylum.  The  general  entrance,  the  porter's  room,  the 
reception  and  visitors'  rooms,  the  clerk  and  steward's  office,  and  store- 
rooms, and  the  other  offices,  should  be  placed  on  the  north  side  cf  the 
building. 


126 

Character  of  Building. 

3.  As  the  building  is  intended  for  the  accommodation  of  pauper 
patients,  all  superfluous  external  decoration  should  be  avoided;  at  the 
same  time  it  should  be  rendered  as  cheerful  and  attractive  as  due  consid- 
eration of  economy  will  permit. 

Separation  of  Sexes,  and  Classification. 

4.  The  accommodation  for  the  male  and  female  patients  should  be  kept 
distinct  on  either  side  of  the  centre,  and  the  building  should  be  so  con- 
structed as  to  admit  of  the  separation  of  the  male  and  female  patients, 
respectively,  into  three  classes.  As  a  general  rule  the  numbers  in  each 
class  should  be  such  as  to  require  the  services  of  not  less  than  two 
attendants. 

Stories. 

5.  The  building  may  consist  of  three  stories,  provided  the  uppermost 
story  be  devoted  to  sleeping  accommodation. 

Buildings  for  Working  Patients. 

6.  Buildings  of  a  cheap  and  simple  character,  consisting  merely  of 
associated  day -rooms  and  dormitories,  without  long  corridors  or  other 
expensive  arrangements,  should  be  provided  for  the  use  of  working 
patients.  These  buftdings  should  be  placed  in  connection  with  the 
washhouse  and  laundry  on  the  female  side,  and  be  conveniently  situate 
in  reference  to  the  workshops  and  farm  buildings  on  the  male  side. 

For  Idiotic  and  Epileptic  Patients. 

Provision  of  an  equally  simple  and  inexpensive  description  should  also 
be  made  for  a  portion  of  the  idiotic  and  ej^ileiDtic  j)atients,  and  also  for 
chronic  cases. 

Size  of  Chapel  and  Offices. 

7.  The  chapel  and  all  offices  and  parts  of  the  building  common  to  the 
establishment — such  as  the  kitchen  and  scullery,  the  washhouse  and 
laundry,  the  workshops  and  storerooms,  should  be  sufficiently  sj^acious 
to  meet  the  prospective  wants  of  the  asylum  in  case  of  an  increase  in 
the  number  of  patients. 

Position  of  Chapel. 

8.  The  chapel  should  not  be  placed  over  the  kitchen.  It  should  be 
capable  of  comfortably  accommodating  at  least  three  fourths  of  the 
patients.  It  should  have  the  usual  character  and  arrangement  of  a 
church,  and  contain  no  special  or  peculiar  provision  for  the  separation  of 
the  sexes. 

General  Dining  Hall. 

9.  A  general  dining  hall,  conveniently  situate  with  reference  to  the. 
kitchen,  and  capable  of  being  made  available  for  the  purposes  of  recrea- 
tion, should  be  provided  for  the  patients  of  both  sexes. 


127 

Officers'  Residences. 

10.  A  good  residence  should  be  provided  for  the  Medical  Superin- 
tendent, with  kitchen  and  other  necessary  domestic  offices.  Suitable 
apartments  of  moderate  extent  should  also  be  provided  for  the  Assistant 
Medical  Officer,  the  Steward,  and  the  Matron,  but  for  these  officers  a 
separate  kitchen  is  not  required. 

Domestic  Servants. 

There  should  also  be  sleeping  accommodation  for  the  domestic  servants 
of  the  institution,  with  whom  might  conveniently  be  associated  those 
patients  who  habitually  work  in  the  kitchen. 

Fropo?iion  of  Single  Booms. 

11.  The  proportion  of  single  rooms  throughout  the  Asylum  need  not 
exceed  one  third.  The  single  rooms  should  be  chiefly  in  the  wards 
appropriated  to  the  excited  and  the  sick.  A  few  should  be  available  for 
special  cases  in  the  other  wards. 

Arrangement  of    Upj^er  Stories — Passages  and  Corridors. 

12.  In  the  upper  stories  passages  of  communication  of  moderate  width 
should  be  adopted  in  lieu  of  wide  corridors,  and  the  dormitories  should 
be  placed  to  the  south.  Generally,  long,  wide,  and  expensive  corridors 
should  not  be  constructed,  but  only  so  much  passage  or  corridor  pro- 
vided as  may  be  absolutely  necessary  to  connect  the  several  parts  of  the 
building. 

Stairs. 

13.  The  stairs  should  be  built  of  stone,  without  windows  or  long, 
straight  flights.  The  well  should  be  built  up,  and  hand  rails  should  be 
provided. 

Staircases. 

14.  The  staircases  should  be  so  arranged  that  the  medical  officer, 
attendants,  and  others  may  pass  through  from  one  part  to  another  with- 
out necessarily  retracing  their  steps. 

Material  for  Floors — Provision  Against  Fire. 

15.  All  the  corridors  and  day  and  sleeping  rooms  should  have  boSrded 
floors,  and  it  is  desirable  that  the  boards  should  be  tongued.  It  is  indis- 
pensable that  they  should  be  of  the  best  wood,  and  thoroughly  well 
seasoned.  The  floors  of  the  sculleries,  lavatories,  and  water  closets 
need  not  be  of  wood.  There  should  be  a  disconnection  of  the  floor  and 
joists  at  all  the  internal  doorways,  by  means  of  a  stone  sill;  and  in  all 
cases  where  a  fireproof  construction  is  not  adopted  similar  separations, 
at  not  greater  distances  apart  than  fifty  feet,  should  be  made  in  the  floors 
and  joists  of  the  galleries  or  corridors.  Provision  should  also  be  made 
for  a  complete  fireproof  separation  of  the  timbers  of  the  roof  at  the 
same  distance,  and  the  parapet  should  be  carried  through  the  roof  one 
foot  above  the  slating.  Oak  floors,  capable  of  being  cleaned  by  dry 
rubbing,  are  preferable  for  the  corridors  and  day  rooms. 


128 

Plastering. 

The  walls  of  the  galleries  and  rooms  generally  should  be  plastered. 

Number  of  Beds  in  Dormitories. 

16.  No  associated  bedrooms  should  be  designed  to  contain  less  than 
three  beds. 

Height  of  Each  Story,  and  Dimensions  of  Booms. 

17.  The  general  height  of  each  story  should  not  be  less  than  eleven 
feet.  The  associated  dormitories  should  not  contain  less  than  fifty  feet 
superficial  to  each  bed  or  patient. 

Dormitories. 

The  separate  sleeping  rooms  generally  should  be  of  not  less  than  the 
following  dimensions,  viz:  nine  feet  by  seven  superficial,  and  eleven  feet 
high.  Those  appropriated  to  sick  or  bedridden  patients  should  be  of 
somewhat  larger  dimensions,  and  some  of  these  should  be  provided  with 
a  fireplace. 

Size  of  Day  Booms. 

18.  The  day  rooms,  of  which  there  should  be  at  least  one  in  each 
ward,  should  contain  not  less  than  twenty  feet  superficial  for  each 
patient,  and  should  be  calculated  for  the  whole  of  the  patients  in  each 
ward,  exclusive  of  corridors  or  galleries. 

Position  of  Day  Booms, 

19.  The  day  rooms  should  be  so  arranged  as  to  afford  ready  commu- 
nication with  the  grounds,  and  those  appropriated  to  the  aged  and  infirm 
should  be  on  the  lowermost  stories. 

Attendants'  Booms. 

20.  Eooms  should  be  provided  for  two  or  more  attendants  to  each 
ward,  and  single  attendants'  rooms  should  not  be  of  less  dimensions 
than  one  hundred  and  twenty  feet,  and  whenever  practicable,  these 
should  be  placed  between  two  dormitories,  with  glazed  doors  of  com- 
mun^ation. 

Windows. 

21.  The  windows  of  the  day  rooms  and  corridors  should  be  large  and 
of  a  cheerful  character,  and  every  one  be  made  to  open  easily,  and  so  as 
to  allow  a  free  circulation  of  air,  but  not  so  far  as  to  expose  patients  to 
danger.  The  wall  below  should  not  be  sloped  or  splayed,  but  recessed, 
to  admit,  if  requisite,  of  a  seat.  In  the  dormitories  and  single  rooms  the 
windows  should,  as  a  general  rule,  not  be  placed  more  than  four  feet 
from  the  floor. 

Shutters. 

Sliding  shutters  should  be  provided  for  a  majority  of  the  single  sleep- 
ing rooms. 


'  129 

Doors. 

22.  The  doors  of  the  single  rooms  should  open  outward,  and  be  eo 
hung  that  when  oj^en  they  will  fold  back  close  to  the  wall. 

Lavatories,  Baths,  and  Water  Closets. 

23.  In  each  ward  there  should  be  conveniences  for  washing  the  person, 
a  slop  room  containing  a  sink,  a  store  room  or  closet,  water  closets,  and 
a  bath.  (In  many  instances  the  bath  room  may  be  so  arranged  as  to  be 
available  for  two  or  more  wards.)  It  is  very  desirable  that  all  water 
closets,  lavatories,  etc.,  should  be  placed  in  projections. 

Infirmaries. 

24.  Suitable  infirmaries,  in  the  proportion  of  at  least  one  tenth  of  the 
whole,  should  be  provided  in  which  the  cubical  contents  of  the  sleeping 
rooms  should  be  greater  than  in  other  parts  of  the  building;  and  every 
room,  including  the  single  rooms,  should  have  an  open  fireplace.  A 
small  day  room  in  each  infirmary  is  also  desirable. 

Wannhig. 

25.  All  the  day  rooms  and  galleries  should  be  warmed  by  means  of 
open  fireplaces,  or  open  fire  stoves,  and  in  large  rooms  two  fires  should 
be  provided.  Fireplaces  should  also  be  built  in  all  associated  dormi- 
tories. In  large  rooms,  such  as  the  chapel  or  general  dining  hall,  and 
in  the  corridor,  further  provision  for  warming  may  be  necessary  by 
means  of  some  simple  system  of  hot  w^ater  pipes  in  connection  with  the 
open  fire  stoves  or  fires.    » 

Ventilation. 

26.  The  ventilation  generally  should  be  provided  for  by  means  of  flues 
taken  from  the  various  rooms  and  corridors  into  horizontal  channels 
connecting  with  a  perpendicular  shaft,  in  which  a  fire  box  should  be 
placed  for  the  purpose  of  extracting  the  foul  air. 

Smoke  Flues. 

27.  In  all  cases  where  descending  or  horizontal  smoke  flues  are  used, 
they  should  be  entirely  constructed  of  brickwork,  rendered  or  pargetted 
inside  and  out;  and  flues  from  any  of  the  heating  or  other  furnaces, 
which  are  carried  up  through  any  of  the  main  walls,  should  be  con- 
structed with  a  hollow  space  round  them  to  prevent  the  inconvenient 
transmission  of  heat  into  the  building  during  the  warm  periods  of  the 
year^  and  to  allow  of  a  moderation  of  the  temperature  of  the  building 
at  other  periods,  when,  owing  to  a  change  in  the  atmosphere,  it  may 
become  inconveniently  hot. 

Ventilating  Flues. 

28.  Whenever  ventilating  flues  are  constructed  of  inflamable  material, 
such  a  quartering,  lathed  and  plastered  a  distance  of  at  least  twenty 

17 


130 

feet  from  their  point  of  coDnection  with  any  shaft,  furnace,  rarifiying 
chamber,  or  smoke  fine,  must  be  constructed  entirely  of  brick,  stone,  or 
other  fireproof  material.  The  rarifyiug  chamber  for  ventilation, 
together  with  the  adjoining  roof,  must  be  entirely  fireproof;  and  a  com- 
munication should  be  made  with  it  by  means  of  a  slate  or  iron  door 
frame. 

Drainage. 

29.  The  best  and  most  approved  system  of  pipe  or  tubular  drainage 
should  be  adopted,  with  a  sufiicient  fall,  so  as  efiectually  to  carry  off  to 
a  sufiicient  distance  from  the  asylum  the  soil  and  all  other  impurities; 
and  the  sewerage  should  be  collected  in  closed  tanks,  and  so  placed  and 
constructed  as  to  render  the  contents  available  for  agricultural  purposes. 
Means  of  flushing  should  be  provided. 

Airing  Courts. 

30.  The  inclosed  airing  courts  need  not  be  more  than  two  in  number 
on  each  side,  and  should  be  of  ample  extent,  so  as  to  afford  proper  means 
for  healthful  exercise.  They  should  all  be  planted  and  cultivated,  and 
any  trees  already  existing  within  them  should  be  preserved  for  shade. 
The  walls  should  be  sunk  in  a  haha. 

Rainwater. 

31.  The  whole  of  the  rainwater  from  the  building  should  be  collected 
in  tanks  suitably  placed,  for  the  purposes  of  the  washhouse,  and  if  pos- 
sible, at  such  levels  as  will  dispense  with  the  labor  of  pumping.  Lead 
is  an  objectionable  material  for  pipes  and  reservoirs,  as  adulterating  the 
vrater. 

Lightning  Conductors. 

32.  Lightning  conductors  should  be  placed  on  the  most  elevated  parts 
of  the  buildino;,  and  they  may  be  connected  with  the  stacks  of  iron  rain 
water  pipes,  which  in  that  case  should  be  fixed  so  as  to  answer  the  double 
purpose  of  rain  water  i:>ipes  and  lightning  conductors.     . 

Farm  Buildings. 

33.  Farm  buildings,  with  suitable  stables,  etc.,  for  visitors'  horses, 
should  be  provided. 

Ko.  3 — Plans  Bequired. 
* 

1.  One  or  more  sheets  of  the  ordnance  map  containing  the  county, 
borough,  or  district,  in  respect  to  which  the  asylum  is  to  be  erected,  or 
some  other  large  map,  in  which  the  situation  of  the  proposed  asylum  and 
all  the  public  roads  and  footpaths  in  the  vicinity  thereof  are  fully  de- 
fined. 

Scale  of  100  feet  to  an  Inch. 

2.  A  general  plan  of  the  land  (with  the  block  of  the  buildings  and 
offices)  and  of  the  exercise  grounds,  garden,  and  road  of  approach,  with 
the  levels  of  the  surface  of  the  ground  at  the  quoins  of  the  building, 
offices,  and  fence  walls  figured  thereon. 


131 

Scale  of  20  feet  to  an  Inch. 

3.  Plans  of  the  basoment,  ground,  and  each  other  floor  of  the  building 
and  offices,  also  of  the  roofs  and  gutters  and  of  the  principal  elevation. 

Scale  of  10  feet  to  an  Inch. 

4.  Elevation  of  portions  of  the  principal  front,  and  also  of  any  other 
parts  in  which  any  variation  therefrom  takes  place. 

Scale  of  5  feet  to  an  Inch. 

5.  Transverse  and  longitudinal  sections  or  sufficient  portions  thereof 
to  show  the  construction  of  every  portion  of  the  building. 

Scale  of  1  foot  to  one  half  an  Inch. 

6.  Plan  and  section  of  one  separate  sleeping  room,  dormitory,  and  eat- 
ing or  day  room  respectively,  or  of  part  of  the  same,  showing  the  method 
of  warming  and  ventilating  each;  also,  of  the  baths  and' washing  rooms 
and  water  closets,  and  the  construction  of  the  apparatus  for  each. 

7.  An  abstract  of  the  draft,  contract,  and  specifications,  giving  a  con- 
cise statement  of  the  whole  of  the  intended  work,  and  also  a  detailed 
estimate  of  the  building,  and  the  prices  at  which  the  different  materials 
and  w^orkmanship  have  been  calculated  in  making  the  estimate. 

8.  The  thicknesses  of  the  Avails,  and  the 'scantlings  of  the  timbers  of 
the  floors  and  roofs  to  be  figured. 

9.  The  general  system  of  heating  and  ventilation  proposed  to  be 
adopted  throughout  the  asylum,  to  be  fully  described  in  the  drawings 
and  specifications. 

10.  Each  i^lan  to  show"  the  several  classes  and  number  of  patients  to 
be  accommodated  in  the  wards,  day  rooms,  dormitories,  cells,  galleries, 
and  airing  courts,  respectively,  to  which  each  plan  relates. 

SUGGESTIONS    Ot'    THE    SCOTCH    BOARD. 

The  following  suggestions  and  instructions  by  the  Scotch  Board  of 
Commissioners  are  the  only  ones  differing  from  those  by  the  English 
Commissioners: 

Suggestions  and  Instructions  in  Reference  to  (1)  Sites;  (2)  Construction  and 
Arrangement  of  Buildings;  (3)  Plans  of  Lunatic  Asylums;  by  the  CommiS' 
sioners  in  Lunacy  for  Scotland. 

Locality. 

(First  part  of  description  same  as  for  England  and  Wales.)  The 
asylum  should  be  within  such  distance  of  a  town  as  to  command  the 
introduction  of  gas,  water,  etc.,  and  of  one  of  sufficient  size  to  afford 
the  means  of  amusement  and  recreation  for  the  medical  staff',  the  attend- 
ants, and  such  of  the  patients  as  might  derive  benefit  from  a  change  in 
the  asylum  routine. 

Supply  and  Quality  of  Water. 
(First  part,  same  as  for  England  and  Wales.)     The  quantity,  exclusive 


132 

of  rain  water,  which  should  be  collected  in  cisterns  on  the  roof,  should, 
at  the  dryest  season,  be  not  less  than  forty  gallons  per  patient  per  diem, 
and  the  amount  should  be  accurately  gauged. 

jVb,  2 — Construction  and  Arrangements  of  Buildings — Entrance  and   Offices 

to  the  North. 

2.  There  should  be  no  road  of  approach  or  public  entrance  traversing 
the  grounds. 

The  general  entrance,  the  porter's  room,  the  reception  rooms,  the 
committee  room,  the  store  rooms,  and  the  other  offices  should  be  so 
placed  as  not  to  interfere  with  the  amenity  of  the  buildings  occupied  by 
the  patients. 

Buildings   for    Working    Patients — For    Idiotic  and   Epilejjtic   Patients — 

Cottages. 

6.  (First  part,  same  as  for  England  and  Wales.)  Provision  of  an 
equally  simple  and  inexpensive  description  might  also  be  made  for  a 
portion  of  the  idiotic,  imbecile,  and  fatuous  patients,  and  also  for  chronic 
cases;  or  cottages  might  be  erected  for  the  accommodation  of  a  large 
proportion  of  the  working  and  inoffensive  patients,  who  might  be  placed 
either  under  the  care  of  the  families  of  the  attendants,  or  of  cottage 
tenants  of  the  asylum. 

Position  of  Chapel. 

8.  The  chapel  should  be  of  easy  access,  and  it  should  be  capable  of 
comfortably  accommodating  at  least  three  fourths  of  the  patients. 
(Eemainder  of  description  same  as  for  England  and  Wales.) 

General  Pining  Hall,  Library,  and  Beading  Boom. 

9.  A  general  dining  hall,  conveniently  situated  with  reference  to  the 
kitchen,  should  be  jn-ovided  for  the  patients  of  both  sexes;  and  also  a 
library  and  reading  room,  capable  of  serving  for  the  general  purposes  of 
instruction  and  recreation. 

Arrangement  of  Pay  Booms  and  Pormitories. 

12.  Passages  of  communication  of  moderate  width  should  be  adopted 
in  lieu  of  wide  corridors,  and  the  day  rooms  and  dormitories  should  be 
placed  on  one  side,  and  to  the  south.  Under  certain  circumstances 
the  day  rooms  and  dormitories  ma}^  occupy  the  whole  breadth  of  the 
building. 

Cottages. 

32.  The  cottages,  if  adopted,  should  be  of  different  sizes,  each  calcu- 
lated to  accommodate  from  three  to  five  patients,  in  addition  to  the 
family  of  the  occupier.  The  male  patients  should  be  placed  either  in 
single  rooms  or  in  dormitories  for  three  or  four,  and  each  cottage  should 
contain  a  water  closet. 

Farm  Buildings. 

33.  Farm  buildings,  with  suitable  stables,  etc.j  should  be  provided,  aind 


133 

also  workshops,  suitable  for  the  employment  of  the  patients  according 
to  the  prevalent  occuj)ations  of  the  district. 

English  Commissioners  on  Size  of  Hospitals. 

The  English  Commissioners  of  Lunacy  are  of  opinion  that  an  asylum 
to  contain  four  hundred  to  five  hundred  patients  is  the  best  size,  but 
that  on  an  emer2;ency  they  may  be  enlarged  to  contain  six  hundred  to 
seven  hundred  patients  without  sacrificing  the  special  characters  which 
all  modern  asj^lums  should  possess.  When  there  are  more  than  seven 
hundred  patients,  the  expenses  increase,  and  all  individual  treatment 
vanishes.  The  Superintendent  can  only  know  the  patients  en  masse,  and 
not  individually,  and  the  establishment  grows  out  of  eifective  super- 
vision, although  the  number  of  attendants  may  be  increased.  This 
opinion  may  be  found  in  the  reports  of  the  Commissioners  again  and 
again  stated  during  the  last  ten  years.  Thus,  in  eighteen  hundred  and 
fifty-seven  they  state: 

"  It  has  alwaj^s  been  the  opinion  of  this  Board  that  asylums  beyond 
a  certain  size  are  objectionable.  They  forfeit  the  advantage — which 
nothing  can  replace,  whether  in  general  management  or  the  treatment  of 
disease — of  individual  and  responsible  supervision.  To  the  cure  and 
alleviation  of  insanity  few  aids  are  so  important  as  those  which  may  be 
derived  from  vigilant  observation  of  individual  peculiarities;  but  where 
the  patients  are  so  numerous  that  no  medical  officer  can  bring  them 
within  the  range  of  his  personal  examination  and  judgment,  such  oppor- 
tunities are  altogether  lost,  and  amid  the  workings  of  a  great  machine 
the  physician,  as  well  as  the  patient,  loses  his  individuality.  When  to 
this  also  is  added,  what  experience  has  of  late  years  shown,  that  the 
absence  of  a  single  and  undivided  responsibility  is  equally  injurious  to 
the  general  management,  and  the  rate  of  maintenance  for  the  patients 
in  the  large  buildings  has  a  tendency  to  run  higher  than  in  buildings  of 
a  smaller  size,  it  would  seem  as  if  the  only  tenable  plea  for  erecting 
them  ought  to  be  abandoned.  To  the  patients,  undoubtedly,  they  bring 
no  corresponding  benefit.  The  more  extended  they  are,  the  more 
abridged  become  their  means  of  care;  and  this,  which  should  be  the  first 
object  of  an  asylum,  and  by  which  alone  any  check  can  be  given  to  the 
present  gradual  and  steady  increase  in  the  number  of  pauper  lunatics 
requiring  accommodation,  is  unhappily  no  longer  the  leading  character- 
istic of  Colney  Hatch  or  Hanwell." 

The  Scottish  Commissioners  are  equally  opposed  to  large  asylums. 
They  consider  that  no  asylum  should  contain  more  than  three  hundred 
and  fifty  patients;  that  the  individual  treatment  of  a  larger  number  is 
impossible;  and  that  cost  increases  with  anything  above  that  number. 
These  opinions  they  repeatedly  expressed  in  their  various  reports. 

M.  Parchappe,  lately  Inspector  of  Asylums  in  France,  says: 

"After  taking  every  consideration  into  account,  I  think  the  minimum 
of  patients  ought  to  be  fixed  at  two  hundred,  and  the  maximum  at  four 
hundred.  Below  two  hundred  the  economical  advantages  rapidly  decline 
without  compensatory  benefit;  above  four  hundred,  although  the 
economical  advantages  augment,  it  is  at  the  detriment  of  the  utility  of 
the  institution  in  its  medical  character." 


134 

M.  Guislain,  the  eminent  Belgian  authority,  in  his  large  work  on 
insanity,  which  is  quoted  by  Doctor  Arlidge,  says: 

"  It  would  be  absurd  to  bring  together,  in  the  same  place,  a  very  large 
population.  It  would  tend  to  foster  an  injurious  degree  of  excitement, 
w^ould  render  the  management  difficult  or  impossible,  would  destroy  the 
unity  of  plan,  and  neutralize  all  scientific  effort.  The  maximum  number 
ought  not  to  exceed  three  hundred  or  three  hundred  and  fifty  insane 
persons." 

Doctor  Arlidge,  in  his  work  on  "  The  State  of  Lunacy,"  mentions  the 
opinions  of  Eoller  and  Damerow — two  of  the  most  eminent  of  German 
alienist  physicians — on  this  subject,  both  of  whom  consider  that  asylums 
for  acute  cases  should  be  limited  to  two  hundred  and  fifty,  but  that  those 
for  both  acute  and  chronic  cases  may  admit  from  four  hundred  and  fifty 
to  five  hundred  inmates,  but  no  more;  and  at  page  one  hundred  and 
eighteen  states  his  own  opinion  that  six  hundred  "  represent  the  maxi- 
mum which  can  economically  and  with  just  regard  to  efiicient  govern- 
ment and  supervision,  and  to  the  interests  of  the  patients,  be  brought 
together  in  one  establishment." 

OBSERVATIONS    ON    FOREGOING    PROPOSITIONS. 

We  have   preferred  the   suggestions  of  associations  and   the  recom- 
mendations of  bodies  of  men  high  in   authority  to  anything  we  might 
have  said  on  these  subjects,  for  the  reason  that   they  will  be  justly 
regarded  as  the  results  of  wisdom  and  experience,  w^orthy  of  attention 
and  thoughtful  consideration;    whereas  the  same  suggestions  from  us 
might  be  considered  as  the   expression  of  individual  opinion,  carrying 
with  it  no  weight  of  authority.     The  good  of  the  cause  is  what  we  desire 
to  promote,  and  for  this  reason  have  not  hesitated  in  any  instance  to 
make  free  use  of  the  ideas  or  words  that  the  wisdom  of  others  have 
given  to  the  world.     With  no  experience  of  our  own,  we  have  endeavored 
to  carry  out  the  instructions  of  our  mission — to  collect,  compile,  and 
report   the   result   of  other   men's   experience.      We   have,    of  course, 
exercised  our  own  judgment  in  drawing  conclusions,  after  listening  to 
the  arguments  and  observing  the  particular  operations  of  theories;  and 
all  of  our  deductions  have  been  made  upon  this  basis.     When  we  say, 
therefore,  that  the  next  asylum  should  be  established  for  the  accommo- 
dation of  the  City  of  San  Francisco  and  the  counties  around  the  Bay, 
and  on  this  account  should  be  located  in  that  vicinity,  we  are  only  carry- 
ing out  the  ideas  of  others,  and  obeying  a  law  of  common   sense  and 
universal  experience;  and  when  we  suggest  that  another  asylum  will  be 
necessary  in  the  northern  and  still  another  in  the  southern  portion  of 
the  State,  ere  many  years  shall  have  clasped,  it  is  in  obedience  to  the 
dictates  of  the  same  ideas  and  natural  laws.     It  will  be  seen  from  the 
foregoing  suggestions  that    the    English    Board  of    Commissioners  in 
Lunacy  regard  hospitals  that  will  accommodate  from  four  to  six  hun- 
dred as  the  best  size  for  the  pauper  class  of  patients;  while  in  Scotland, 
owing  possibly  to  the  fact  that  both  private  and  pauper  patients  are 
more  generally  received  in  the  same  asylums  than  in  England,  the  Board 
expressed  the  opinion  that  three  hundred  and  fifty  should  constitute  the 
largest  number  that  could  be  properly  accommodated  in  one  institution. 
The  best  authorities  at  this  time  in  France,  Germany,  Switzerland,  Italy, 
and  Belgium  have  placed  the  limits  at  four  hundred,  and  in  the  United 


135 

States,  until  very  recently,  the  Superintendents,  in  their  collective 
capacity,  declared  that  two  hundred  and  fifty  should  never  be  exceeded. 
But  in  eighteen  hundred  and  sixty-six  they  so  far  modified  this 
expression  as  to  say  that  under  certain  peculiar  circumstances  the 
number  might  be  carried  to  the  extent  of  accommodating  six  hundred 
l^atients. 

This  concession  was  made,  as  we  have  been  informed  by  most  of  those 
giving  their  consent  to  its  utterance,  more  to  what  seemed  to  be  a 
necessity,  than  from  convictions  of  propriet}',  most  of  them  still  adher- 
ing to  the  correctness  of  the  original  declaration — such  too,  as  will  be 
seen  from  the  Massachusetts  Eeport  on  Insanity  and  Idiocy,  page  one 
hundred  and  thirty -four,  a  copy  of  which  will  be  found  in  our  State 
Library,  was  the  opinion  of  most  of  the  Medical  Superintendents  in 
Europe  and  America  at  the  time  that  report  was  w^ritten. 

PRESENT    CUSTOM   IN    ALL    COUNTRIES. 

Notwithstanding  the  modifications  that  have  been  made  in  this  respect, 
and  notwithstanding  the  further  fact  that  most  of  the  asylums  being 
erected  at  the  present  time  are  intended  for  the  accommodation  of  from 
four  hundred  to  six  hundred,  both  in  the  Old  World  and  the  New,  our 
observations  of  the  practical  workings  of  asylums  of  all  sizes,  compels 
the  conviction  that  all  things  taken  into  consideration  the  smaller  num- 
ber— two  hundred  and  fifty — is  the  best;  and  that  under  no  circum- 
stances should  this  number  be  exceeded  under  one  roof.  If  this  should 
be  deemed  too  small,  it  might  with  propriety  be  supplemented  by  addi- 
tional separate  buildings  for  the  accommodation  of  one  hundred  and  fifty 
more;  one  with  a  capacity  for  fifty  patients  of  the  convalescent  class,  for 
both  sexes,  and  two  others  of  equal  size — one  for  the  inolfensive  and 
quiet  males,  who  may  or  may  not  labor  on  the  farm,  in  the  garden,  or 
shops,  and  the  other  for  females  of  the  same  class,  who  may  work  in  the 
laundry  or  sewing  room.  Such  buildings  may  be  seen  at  many  of  the 
asylums  in  England  and  Scotland,  as  well  as  on  the  Continent,  and  are 
not  only  pleasant  features,  but  are  considered  of  so  much  value  in  the 
treatment  of  the  patients,  and  the  general  management  of  the  asylums, 
that  we  were  assured  by  the  Superintendents  that  they  would  not  dis- 
pense with  them  on  any  account.  They  are  by  no  means  uniform  in 
the  i^roportions  which  they  accommodate,  nor  as  to  the  classes  we  have 
specified  above.  They  are  usually  more  cheaply  constructed  than  the 
main  buildings,  and  free  from  the  grated  or  barred  windows  and  other 
necessary  arrangements  made  use  of  in  the  main  building  as  precautions 
against  escape  or  injury.  They  are  warmed  by  open  fireplaces,  and  are 
surrounded  by  their  own  little  gardens,  redolent  with  flowers  and  beau- 
tified with  shrubs  cultivated  by  the  patients.  Of  course  they  are  never 
left  to  themselves,  as  it  is  a  universal  law  that  no  ward  of  a  hospital 
should,  under  any  circumstances,  be  left  without  an  attendant,  even  for 
a  short  time;  otherwise  serious  accidents  might  be  the  result. 

DINING    HALLS    IN    EUROPEAN    ASYLUMS. 

In  Great  Britain  and  Ireland,  as  w^ell  as  on  the  the  continent,  the  pa- 
tients take  their  meals  in  a  common  dining  hall,  the  males  occupying 
seats  on  one  side  the  hall  and  the  females  on  the  other.  When  the  num- 
bers are  too  great  for  this  arrangement  to  be  practicable,  two  dining 
halls  are  provided,  one  for  either  sex,  and  are  situated  on  either  side  of 


136 

the  kitchen.  At  Newcastle-upon-Tyne  they  not  only  dine  in  the  same 
hall,  but  sit  where  they  please;  and  it  was  interesting  to  observe  that 
while  the  first  tables  on  the  female  side  of  the  room  were  occupied 
exclusively  by  them,  and  so  with  the  males  on  their  side,  that  the  next 
set  of  tables  had  a  sprinkling  of  the  opposite  sex,  and  so  on  till  the  cen- 
tre tables  were  reached,  which  were  occupied  by  about  an  equal  number 
of  either  sex.  Doctor  AYickham  informed  us  that  this  Avas  always  the 
case,  and  that  he  had  never  experienced  the  least  excitement  or  trouble 
on  this  account.  For  these  reasons  the  patients  occupying  the  detached 
buildings  of  which  we  have  spoken  resorted  to  the  common  dining  halls 
for  their  meals,  with  the  exception  of  the  convalescent  patients,  who 
were  in  some  instances  provided  with  meals  in  their  own  establishment. 

ASYLUM    SHOULD    NOT    BE    ENLARGED. 

When  an  asylum  of  this  size  has  received  its  intended  complement, 
instead  of  building  still  further  additions,  another  should  be  established 
in  another  district  of  the  State,  where  the  population  most  strongly  indi- 
cates its  need,  whether  at  some  other  point  upon  the  Bay — should  San 
Francisco  still  continue  to  pour  its  hordes  into  the  new  asylum  as  it  has 
done  into  the  old — or  in  some  more  distant  part  of  the  State,  in  the 
great  north  or  the  mild  and  genial  south,  must  be  determined  by  the 
condition  of  things  as  they  may  exist  at  the  time.  Of  one  thing  we  are 
positively  certain,  that  so  long  as  the  habits  of  our  people  remain  as 
they  have  been;  so  long  as  the  proportion  of  the  foreign  population 
remains  the  same;  so  long  as  the  causes  of  insanity  remain  unchanged, 
just  so  long  will  insanity  continue  to  be  produced  and  hold  its  present 
ratio  to  the  inhabitants  of  the  State. 

ONE   INSANE    TO    FOUR    HUNDRED    AND    FIFTY   OR   FIVE    HUNDRED   PERSONS. 

We  may  as  well  make  up  our  minds  now  as  at  any  future  time  that 
every  community  of  four  hundred  and  fifty  or  five  hundred  persons  will 
have  to  support  or  provide  for  the  treatment  and  care  of  one  insane  per- 
son. When  this  becomes  to  be  a  recognized  fact  among  the  people,  the 
whole  subject  will  have  been  stripped  of  more  than  half  its  difiiculties 
and  embarrassments,  the  system  for  which  we  have  labored  will  have 
been  established,  and  the  just  and  regular  provision  for  the  insane  will 
be  made  for  their  support,  as  it  is  now  for  the  common  schools  or  the 
ordinary  and  inevitable  expenses  of  the  State  Government.  Until  this 
has  been  accomplished  the  constantly  recurring  and  ever  renewing  ques- 
tion of  provisions  for  the  insane  will  be  brought  before  our  Legislature, 
to  occupy  its  time  and  perplex  its  members. 

ASYLUM   AT   STOCKTON    OVERCROWDED. 

But  there  is  another  question  that  must  not  be  overlooked,  in  our  so- 
licitude for  the  establishment  of  a  new  asylum,  and  which  is  a  matter  of 
equal  concern.  It  is  the  present  crowded  condition  of  the  asylum  at 
Stockton.  With  accommodations  for  not  more  than  six  or  seven  hundred 
patients,  there  are  packed  in  its  Avards  about  eleven  hundred — or  four 
hundred  more  than  it  can  properly  accommodate.  Doctor  Shurtletf  tells 
us  in  his  report,  "  that  beside  two  j^atients  in  the  rooms  intended  for  but 
one,  in  eight  out  of  the  eleven  Avards,  tAvo  hundred  and  twenty-seven 
patients  are  sleeping  on  beds  nightly  prepared  for  them  in  the  halls." 


137 

Two  of  these  wards,  the  second  and  tenth,  intended  for  thirty  patients 
each,  now  have  about  eighty  each.  These  wards  are  poorly  ventilated, 
low,  and  uncomfortable  in  the  extreme,  and  should  be  erased  from  the 
face  of  the  earth  and  the  memory  of  man.  They  never  were  fit  recep- 
tacles for  any  human  being,  and  have  been  tolerated  altogether  too  long. 

INCREASED    MORTALITY. 

To  the  crowded  condition  of  these  wards  and  the  hospital  generally 
must  be  attributed  the  increased  mortality  of  the  last  four  years;  and 
should  it  be  our  misfortune,  which  God  forbid,  to  be  visited  with  cholera 
or  other  epidemic,  there  is  no  place  to  which  these  patients  could  possibly 
be  removed,  and  they  would  consequently  be  swept  away  like  sheep  with 
the  rot.  Let  any  member  of  the  Legislature  visit  these  w^ards  at  bed- 
time, and  if  he  does  not  conclude  that  it  is  a  sin  and  a  shame  not  to  do  some- 
thing for  their  immediate  relief,  we  will  be  willing  to  acknowledge  that  w^e 
ourselves  have  lost  our  reason  and  our  heart,  and  a  fit  subject  for  the 
very  wards  that  we  have  described,  or  that  he  himself  is  in  such  condi- 
tion; for  no  two  sane  men  could  ever  agree  to  the  policy  of  "doing 
nothing,"  after  having  visited  them. 

How  Dr.  Shurtleff  and  his  assistants  have  managed  to  get  along  so 
well,  under  the  disadvantages  with  which  they  have  been  constantly 
beset,  is  a  matter  of  wonder  and  surj)rise,  and  the  untiring  energy 
and  constant  w^atchfulness  that  has  been  displayed  by  them  are  wor- 
thy of  the  highest  commendation,  as  well  as  the  gratitude  of  the  com- 
munity at  large. 

•     NEW    BUILDINGS    SHOULD   BE   FINISHED. 

The  new  building  at  Stockton  is  of  the  most  creditable  character,  and 
when  completed  would  be  considered  a  first  class  asylum  anywhere  in 
the  world;  indeed,  with  a  few  modifications,  w^e  know  of  none  that 
would  be  better  suited  to  the  climate  in  which  it  is  located.  The  press- 
ing demands  for  further  and  immediate  room,  make  it  of  the  greatest 
importance,  nay,  an  absolute  necessity,  that  it  should  be  completed  by 
the  immediate  construction  of  the  north  wing,  and  thus  finish  the  work 
that  has  been  too  long  delayed.  It  is  not  necessary  to  stop  to  discuss 
the  question  as  to  w^hether  Stockton  is  or  is  not  the  j^roper  place  for  the 
location  of  an  insane  asylum.  One  has  been  located  there,  and  has  been 
in  successful  operation  for  the  last  twenty  years.  It  could  not  be 
removed,  even  if  such  an  event  w^ere  desirable.  We  therefore  heartily 
indorse  all  that  Dr.  Shurtleff  has  said  with  regard  to  the  necessities  of 
the  institution  over  w^hich  he  has  so  long  presided,  with  such  marked 
ability  and  success. 

OTHER   PROVISIONS   NEEDED. 

The  strongest  reasons  and  the  plainest  motives  of  sound  policy  would 
indicate  the  propriety  of  providing  for  the  improvements  at  Stockton, 
and  for  a  new  asylum  in  the  same  bill.  The  past  experience  of  Doctor 
Shurtleff,  aided  by  his  Board  of  Trustees,  would  insure  the  completion 
of  the  work  there  in  the  shortest  time  and  best  manner;  when  it  would 
only  remain  for  the  Governor  or  the  Legislature  to  make  a  judicious 

18 


138 

selection  of  the  men  who  are  to  choose  the  site,  decide  upon  the  plan, 
superintend  the  erection  of  the  new  building,  and  control  its  subse- 
quent management. 

COMMISSIONERS. 

As  great  power  is  commonly  placed  in  the  hands  of  these  individuals, 
it  will  readily  be  understood  how  important  it  is  that  they  should  be 
men  of  high  character,  strict  integrity,  active  benevolence  and  business 
habits.  They  should  be  willing  to  inform  themselves  of  the  character 
and  responsibility  of  the  high  trust  confided  to  them,  and  should  heartily 
avoid  taking  any  step  that  might  mar  to  a  greater  or  less  extent  the 
usefulness  of  the  institution  as  long  as  it  may  exist. 

SITE. 

Great  caution  should  be  observed  in  the  selection  of  a  site,  as  the  best 
style  of  building  and  most  liberal  organization  can  never  compensate 
for  the  loss  sustained  by  a  location  that  deprives  the  patients  of  valuable 
privileges,  or  subjects  them  to  annoyances;  nearness  to  manufacturing 
establishments,  houses  of  correction,  penitentiaries,  or  other  public  insti- 
tutions calculated  to  disturb  the  quiet  or  unpleasantly  affect  the  mind 
of  the  patients  should  be  especially  avoided.  Great  stress  is  laid  upon 
all  of  these  matters  both  by  the  Commissioners  of  England  and  the 
Superintendents  of  our  own  country.  As  has  been  observed  by  Doctor 
Kirkbride,  than  whom  no  better  authority  can  be  found:  "It  is  now 
well  established  that  this  class  of  hospitals  should  always  be  located  in 
the  country  not  within  less  than  two  miles  of  a  town  of  considerable 
size,  and  they  should  be  easily  accessible  at  all  seasons.  They  should, 
if  possible,  be  near  turnpikes  or  other  good  roads,  or  on  the  line  of  a 
railroad.  While  two  or  three  miles  from  a  town  might  be  named  as  a 
good  distance  on  the  former,  the  facilities  afforded  by  a  railroad  might 
make  ten  or  twelve  miles  unobjectionable;  for  it  is  the  time  spent  in 
passing  and  ease  of  access  that  is  most  important.  Proximity  to  a  town 
of  considerable  size  has  many  advantages,  as  in  procuring  supplies, 
obtaining  domestic  help,  or  mechanical  workmen,  and  on  account  of  the 
various  matters  of  interest  not  elsewhere  accessible  to  the  patients.  In 
selecting  a  site,  facility  of  access  from  the  districts  of  country  from 
which  the  patients  will  be  principally  derived  should  never  be  over- 
looked." 

SHOULD  BE  IN  A  HEALTHY  LOCALITY. 

The  building  should  be  in  a  healthful,  pleasant,  and  fertile  district  of 
country;  the  land  chosen  should  be  of  good  quality  and  easily  tilled;  the 
surrounding  scenery  should  be  of  a  varied  and  attractive  kind,  and  the 
neighborhood  should  possess  numerous  objects  of  an  agreeable  and  inter- 
esting character.  While  the  hospital  itself  should  be  retired,  and  its 
Xjrivacy  fully  secured,  it  is  desirable  that  the  view  from  it  should  exhibit 
life  in  its  active  forms,  and  on  this  account  stirring  objects  at  a  little 
distance  are  desirable.  Eeference  should  also  be  made  to  the  amount  of 
wood  and  tillable  land  that  may  be  obtained,  to  the  supply  of  water,  and 
to  the  facilities  for  drainage,  and  for  inclosing  the  pleasure  grounds. 

QUANTITY    OF   LAND    NECESSARY. 

While  it  is  the  duty  of  the  State  to  provide  for  and  take  care  of  every 


139 

citizen  who  may  be  afflicted  witti  insanity,  on  the  other  hand  it  is  no 
more  than  right  that  they  should  make  the  burden  as  light  as  possible; 
and  although  we  do  not  believe  in  making  patients  work  for  the  profits 
of  their  labor,  yet  when  they  have  been  accustomed  to  labor  on  the 
farm,  in  the  garden,  or  in  shops  at  home,  and  when  they  are  well  enough 
to  perform  this  labor  at  the  asylum,  not  only  without  detriment  but  with 
advantage  to  their  health  and  improvement  in  their  mental  condition,  it 
should  be  exacted  from  them;  the  Superintendent  in  all  cases  being  the 
judge  as  to  the  results.  In  most  of  the  asylums  in  our  country  too  little 
employment  is  given  to  the  body,  and  too  little  occupation  to  the  mind, 
to  prevent  a  state  of  ennui  that  naturally  follows  the  occuj^ation  "  of 
doing  nothing." 

Many  cannot  labor  for  medical  reasons;  others,  on  account  of  previ- 
ous occupations  and  professions,  have  not  been  taught  to  labor,  and 
require  other  forms  and  methods  of  employment;  yet  all  in  whom  there 
exists  no  special  reason  contraindicating  it  should  be  emj^loyed  in  some 
way  during  a  portion  of  every  day. 

Hence  ever^^  State  Asylum  should  have  at  least  half  an  acre  of  land 
for  each  patient  intended  to  be  accommodated,  not  only  for  farming  and 
gardening  purposes,  but  for  pleasure  and  exercise  grounds  as  well,  as 
the  latter  are  the  most  beautiful  and  attractive  features  of  every  asylum 
where  they  exist,  and  in  wdiich  the  English  Asylums  especially,  so  far 
excel  those  of  all  other  countries  as  a  rule,  and  those  in  our  country 
more  particularly,  where  this  feature  has  been  too  much  neglected. 

Supply  of  Water. 

An  abundant  supply  of  good  water  is  one  of  the  necessaries  of  every 
hospital,  and  should  be  secured  whatever  may  be  the  cost  or  trouble 
required  to  eifect  it.  A  very  extensive  use  of  baths  is  among  the  most 
important  means  of  treatment,  and  the  large  number  of  water  closets 
that  are  indispensable  in  the  wards,  the  great  amount  of  washing  that  is 
to  be  done,  as  well  as  various  other  arrangements  requiring  a  free  use 
of  water,  and  above  all,  abundant  means  for  extinguishing  fire,  in  case 
such  an  accident  should  occur,  make  it  of  the  utmost  im23ortance  that 
the  supply  should  be  permanent  and  of  the  most  liberal  kind. 

The  daily  consumption  for  all  purj^oses  in  an  institution  for  two  hun- 
dred and  fifty  patients  will  not  be  much,  if  any,  less  than  ten  thousand 
gallons,  and  tanks  to  contain  more  than  this  amount  should  be  i^laced  in 
the  dome,  or  highest  part  of  the  building. 

Drainage. 

All  the  drainage  should  be  under  ground;  and  in  selecting  a  site,  facil- 
ities for  making  this  very  important  arrangement  should  never  be  over- 
looked. All  tlie  waste  water  from  the  kitchen,  sculleries,  baths,  water 
closets,  etc.,  should  be  carried  off  beneath  the  surface,  and  to  such  a 
distance  as  will  prevent  the  possibility  of  its  proving  an  annoyance  to 
the  hospital. 

All  the  entrances  to  the  culverts  should  be  trapped,  and  the  culverts 
should  be  made  so  large  and  with  such  a  descent  as  will  obviate  all  risks 
of  obstructions.  If  the  rain  water  from  the  roof  and  the  surface  drainage 
are  taken  in  another  direction,  that  from  the  hospital  may  be  made  to 
add  greatly  to  the  fertility  of  the  farm;  but  it  is  much  better  to  carry 
all  off  through  the  same  culvert  and  lose  this  advantage,  than  incur  the 


140 

slightest  risk  of  having  the  air  in  the  vicinity  of  the  hospital  contami- 
nated by  these  fertilizing  arrangements. 

Inclosiires. 

It  is  desirable  that  the  pleasure  grounds  and  gardens  should  be  securely 
inclosed,  to  protect  the  patients  from  the  gaze  and  impertinent  curiosity 
of  visitors,  and  from  the  excitement  occasioned  by  their  presence  in  the 
grounds. 

This  inclosure  should  be  of  a  permanent  character,  about  ten  feet 
high,  and  so  located  that  ii  will  not  be  conspicuous,  even  if  it  is  at  all 
visible  from  the  building.  The  site,  as  well  as  the  position  of  the  building 
on  it,  should  have  some" reference  to  this  arrangement.  If  sufficient  ine- 
qualities of  surface  exist,  the  wall  or  fence,  as  it  may  be,  should  be  placed 
in  the  low  ground,  so  as  not  to  obstruct  the  view;  but  if  the  country  is 
too  level  to  admit  of  this,  the  same  end  may  be  attained  by  placing  the 
wall  in  the  center  of  a  line  of  excavation  of  sufficient  depth  to  prevent 
its  having  an  unpleasant  appearance,  and  yet  be  entirely  etfective. 
Although^the  first  cost  of  a  wall  will  be  about  double  that  of  a  fence  of 
the  proper  kind,  still,  its  durability  and  greater  efficiency  in  every  re- 
spect will  make  it  cheaper  in  the  end.  The  amount  of  land  thus  inclosed 
should  never  be  less  than  thirty  acres,  while  forty  or  even  fifty  acres 
will  be  a  more  desirable  amount,  so  that  the  pleasure  grounds  of  the 
male  and  female  patients,  which,  as  before  observed,  should  be  entirely 
distinct,  may  be  sufficiently  extensive.  Important  as  I  regard  the  per- 
manent inclosure  of  extensive  pleasure  grounds  and  gardens,  in  the 
manner  suggested,  as  protecting  the  patients  from  improper  observation, 
keeping  out  intruders,  enlarging  the  liberty  of  the  insane  generally, 
securing  various  improvements  from  injury,  and  permitting  labor  to  be 
used  as  a  remedy  for  more  patients  than  could  otherwise  be  done,  still  it 
is  proper  to  add,  that  high  walls  around  small  inclosures,  and  in  full 
view  from  the  buildings,  are  even  less  desirable  than  a  simple  neat  railing, 
which  would  neither  keep  determined  visitors  out  nor  active  patients  in. 
The  first  of  these  objects — keeping  the  public  out — :t  must  not  be  for- 
gotten, is  the  prominent  one  thought  of  in  recommending  a  wall  to  be 
placed  around  the  pleasure  grounds  of  a  hospital.  The  presence  and 
watchfulness  of  intelligent  attendants  must  still  be  the  grand  reliance 
to  prevent  the  escape  of  patients,  and  I  regard  any  arrangement  that 
does  away  with  the  necessity  of  constant  vigilance  undesirable  about  a 
hospital  for  the  insane. 

Patients'  Airing  Courts. 

Although  it  does  not  seem  to  me  desirable  to  have  a  large  number  of 
private  yards  in  immediate  connection  with  a  hospital  for  the  insane,  it 
will  still  be  found  convenient  to  have  two  for  each  sex,  of  a  large  size, 
well  provided  with  brick  walks,  shade  trees,  and  such  other  modes  of 
protection  from  the  sun  and  weather  as  may  be  deemed  useful.  These 
yards  enable  many  patients,  who  at  certain  periods  wish  to  avoid  the 
greater  publicity  of  the  grounds,  to  have  the  benefit  of  the  open  air,  and 
to  take  exercise  at  hours  when  the  attendants  cannot  conveniently  leave 
the  wards;  but  most  of  the  patients  should  have  a  more  active  and 
longer  continued  kind  of  exercise  than  these  yards  aff'ord.  They  should 
look  to  the  walks  in  the  open  fields  and  about  the  grounds,  which  can 
readily  be  made  a  mile  long  for  each  sex  for  their  principal  exercise. 


141 

Four  fifths  of  all  the  patients  will,  under  proper  regulations,  be  able  to 
take  walks  of  this  kind  for  at  least  a  couple  of  hours,  morning  and 
afternoon,  at  all  seasons;  and  in  warm  weather,  when  proper  summer 
houses  and  seats  are  provided,  they  may  thus  profitably  spend  one  half 
the  entire  day  in  the  open  air.  It  is  always  much  better  for  patients  to 
be  comfortably  sealed  in 'a  pleasant  parlor  or  hall  at  any  season  of  the 
year  than  to  be  lying  on  the  ground,  or  otherwise  soiling  their  clothes, 
and  exposing  themselves  to  the  risk  of  taking  cold,  as  is  very  apt  to  be 
the  case  when  certain  classes  are  allowed  to  consult  their  own  pleasure 
as  to  the  mode  of  passing  their  time  while  in  the  small  yards  adjoining 
the  building. 

Size  of  the  Building. 

A  suitable  site  having  been  selected,  it  will  next  become  necessary  to 
decide  upon  the  size  of  the  institution.  Whatever  difference  of  opinion 
may  have  formerly  existed  on  this  point,  I  believe  there  are  none  at 
present.  AH  the  best  authorities  agree  that  the  number  of  insane  con- 
fined in  one  hospital  should  not  exceed  two  hundred  and  fifty,  and  it  is 
very  important  that  at  no  time  should  a  larger  number  be  admitted  than 
the  building  is  calculated  to  accommodate  comfortably,  as  a  crowded 
institution  cannot  fail  to  exercise  an  unfavorable  influence  on  the  welfare 
of  its  patients.  The  precise  number  that  may  be  properly  taken  care  of 
in  a  single  institution  will  vary  somewhat,  according  to  the  ratio  of 
acute  cases  received,  and  of  coarse  to  the  amount  of  personal  attention 
required  from  the  chief  medical  ofiicer.  In  State  institutions,  when  full, 
at  least  one  half  of  all  the  cases  will  commonly  be  of  a  chronic  char- 
acter, and  require  little  medical  treatment.  Even  when  thus  propor- 
tioned, two  hundred  and  fifty  will  be  found  to  be  as  many  as  the  Medical 
Superintendent  can  visit  properly  every  day,  in  addition  to  the  perform- 
ance of  his  other  duties.  Whenever  an  existing  State  institution  built 
for  two  hundred  and  fifty  patients  contains  that  number  and  does  not 
meet  the  wants  of  the  community,  instead  of  crowding  it,  and  thereby 
rendering  all  its  inmates  uncomfortable,  or  materially  enlarging  its 
capacity  by  putting  up  additional  buildings,  it  will  be  found  much  better 
at  once  to  erect  an  entirely  new  institution  in  another  section  of  the 
State,  for  under  any  circumstances  the  transfer  of  acute  cases  from  a 
great  distance  is  an  evil  of  serious  magnitude,  and  constantly  deplored 
by  those  who  have  the  care  of  the  insane. 

Position,  Form,  and  General  Arrangements. 

The  size  of  the  building  having  been  determined,  its  form  and  general 
arrangements  will  next  require  attention;  and  no  plan,  however  beauti- 
ful its  exterior  may  appear,  nor  how  apparently  ingenious  its  interior 
may  seem,  should  be  adopted  without  having  been  first  submitted  to  the 
inspection  and  received  the  approval  of  some  one  or  more  pTiysicians  who  have 
had  a  large  practical  acquaintance  with  thejnsane,  and  who  are  thoroughly 
familiar  with  the  details  of  their  treatment,  as  well  as  with  the  advan- 
tages and  defects  of  existing  hospitals  for  their  accommodation.  So 
different  from  ordinary  buildings  or  other  public  structures  are  hospitals 
for  the  insane,  that  it  is  hardly  possible  for  an  architect,  however  skill- 
ful, or  a  Board  of  Commissioners,  however  intelligent  and  well  disposed, 
unaided  to  furnish  such  an  institution  with  all  the  conveniences  and 
arrangements  indispensable  for  the  proper  care  and  treatment  of  its  pa- 
tients.   No  desire  tb  make  a  beautiful  and  pidture^que  exteridr  should 


142 

ever  be  allowed  to  interfere  with  the  internal  arrangements.  The  inte- 
rior should  be  first  planned,  and  the  exterior  so  managed  as  not  to  spoil 
it  in  any  of  its  details. 

A  hospital  for  the  insane  should  have  a  cheerful  and  comfortable  appear- 
ance; everything  repulsive  and  prison-like  should  be  carefully  avoided, 
and  even  the  means  of  effecting  the  proper  degree  of  security  should  be 
masked,  as  far  as  possible,  by  arrangements  of  a  pleasant  and  attractive 
character.  For  the  same  reason  the  grounds  about  the  building  should 
be  highly  improved  and  tastefully  ornamented;  a  variety  of  objects  of 
interest  should  be  collected  around  it,  and  trees  and  shrubs,  flowering 
plants,  summer  houses,  and  other  pleasing  arrangements  should  add  to 
its  attractiveness.  No  one  can  tell  how  important  all  these  may  prove 
in  the  treatment  of  patients,  nor  what  good  effects  may  result  from  first 
impressions  thus  made  upon  an  invalid  on  reaching  a  hospital — one  who, 
perhaps,  had  left  home  for  the  first  time,  and  w^as  looking  forward  to  a 
gloomy,  cheerless  mansion,  surrounded  by  barren,  uncultivated  grounds, 
for  his  future  residence,  but  on  his  arrival  finds  everything  neat,  tasteful, 
and  comfortable. 

Nor  is  the  influence  of  these  things  on  the  friends  of  patients  unim- 
portant. They  cannot  fail  to  see  that  neither  labor  nor  expense  is  spared 
to  promote  the  happiness  of  the  patients,  and  they  are^thus  led  to  have 
a  generous  confidence  in  those  to  whose  care  their  friends  have  been 
intrusted,  and  a  readiness  to  give  a  steady  support  to  a  liberal  course  of 
treatment. 

Great  care  should  be  observed  in  locating  the  building,  that  every  pos- 
sible advantage  may  be  derived  from  the  views  and  scenery  adjacent, 
and  especially  from  the  parlors  and  other  rooms  occupied  during  the  day. 
The  prevailing  winds  of  Summer  may  be  also  made  to  minister  to  the 
comfort  of  the  inmates,  and  the  grounds  immediately  adjacent  to  the 
hospital  should  have  a  gradual  descent  in  all  directions,  to  secure  a  good 
surface  drainage. 

PROPOSITIONS     RELATIVE     TO     THE     ORGANIZATION     OF     HOSPITALS     FOR     THE 

INSANE. 

I.  The  general  controlling  powers  should  be  invested  in  a  Board  of 
Trustees  or  Managers;  if  of  a  State  institution,  selected  in  such  manner 
as  will  be  likely  most  effectually  to  protect  it  from  all  influences  con- 
nected with  political  measures  or  political  changes;  if  of  a  private  cor- 
poration, by  those  properly  authorized  to  vote. 

II.  The  Board  of  Trustees  should  not  exceed  twelve  in  number,  and 
be  composed  of  individuals  possessing  the  public  confidence,  distin- 
guished for  liberality,  intelligence,  and  active  benevolence,  above  all 
political  influence,  and  able  and  willing  faithfully  to  attend  to  the  duties 
of  their  station.  Their  tenure  of  office  should  be  so  arranged  that  when 
changes  are  deemed  desirable  the  terms  of  not  more  than  one  third  of 
the  whole  number  should  expire  in  any  one  year. 

III.  The  Board  of  Trustees  s*hould  appoint  the  Physician,  and,  on  his 
nomination,  and  not  otherwise,  the  Assistant  Physician,  Steward,  and 
Matron.  They  should,  as  a  Board,  or  by  committee,  visit  or  examine 
every  part  of  the  institution  at  frequent  stated  intervals,  not  less  than 
semi-monthly,  and  at  such  other  times  as  they  may  deem  expedient,  and 
exercise  so  careful  a  supervision  of  the  expenditures  and  general  opera- 
tions of  the  Hospital  as  to  give  to  the  community  a  proper  degree  of 
confidence  in  the  correctness  of  its  management. 


143 

IV.  The  Physician  should  be  the  Superintendent  and  chief  executive 
officer  of  the  establishment.  Besides  being  a  well  educated  phj^sician, 
he  should  possess  the  mental,  physical,  and  social  qualities  to  tit  him  for 
the  post.  He  should  serve  during  good  behavior,  reside  on  or  very 
near  the  premises,  and  his  compensation  should  be  so  liberal  as  to  enable 
him  to  devote  his  whole  time  and  energies  to  the  welfare  of  the  Hospital. 
He  should  nominate  to  the  Board  suitable  persons  to  act  as  Assistant 
Physician,  Steward,  and  Matron.  He  should  have  entire  control  of  the 
medical,  moral,  and  dietetic  treatment  of  the  patients,  the  unrestricted 
power  of  appointment  and  discharge  of  all  persons  engaged  in  their 
care,  and  should  exercise  a  general  supervision  and  direction  of  every 
department  of  the  institution. 

V.  The  Assistant  Physician,  or  Assistant  Physicians  where  more  than 
one  are  required,  should  be  graduates  of  medicine,  of  such  character 
and  qualifications  as  to  be  able  to  represent  and  to  perform  the  ordinary 
duties  of  the  Physician  during  his  absence. 

VI.  The  Steward,  under  the  direction  of  the  Superintending  Physi- 
cian, and  by  his  order,  should  make  all  purchases  for  the  institution, 
keep  the  accounts,  make  engagements  with,  pay,  and  discharge  those 
employed  about  the  establishment,  have  a  supervision  of  the  farm, 
garden,  and  grounds,  and  perform  such  other  duties  as  may  be  assigned 
him. 

VII.  The  Matron,  under  the  direction  of  tjtie  Superintendent,  should 
have  a  general  supervision  of  the  domestic  arrangements  of  the  house, 
and,  under  the  same  direction,  do  what  she  can  to  i^romote  the  comfort 
and  restoration  of  the  patients. 

VIII.  In  institutions  containing  more  than  two  hundred  patients,  a 
Second  Assistant  Physician  and  an  Apothecary  should  be  employed;  to 
the  latter  of  whom  other  duties,  in  the  male  wards,  may  be  conveniently 
assigned. 

IX.  If  a  chaplain  is  deemed  desirable  as  a  permanent  officer,  he  should 
be  selected  by  the  Superintendent;  and,  like  all  others  engaged  in  the 
care  of  the  patients,  should  be  entirely  under  his  control. 

X.  In  every  asylum  for  the  insane  there  should  be  one  supervisor 
for  each  set,  exercising  a  general  oversight  of  all  the  attendants  and 
patients,  and  forming  a  medium  of  communication  between  them  and 
the  officers. 

XL  In  no  institution  should  the  number  of  persons  in  immediate 
attendance  on  the  patients  be  in  a  lower  ratio. than  one  attendant  for 
every  ten  patients;  and  a  much  larger  proportion  of  attendants  will 
commonly  be  desirable. 

XII.  The  fullest  authority  should  be  given  to  the  Superintendent  to 
take  every  precaution  that  can  guard  against  fire  or  accident  within  an 
institution,  and  to  secure  this  an  efficient  night  watch  should  always  be' 
provided. 

XIII.  The  situation  and  circumstances  of  different  institutions  may 
require  a  considerable  number  of  persons  to  be  employed  in  various 
other  positions;  but  in  every  hospital,  at  least  all  those  that  have  been 
referred  to,  are  deemed  not  only  desirable,  but  absolutely  necessary  to 
give  all  the  advantages  that  may  be  hoped  for  from  a  liberal  and  enlight- 
ened treatment  of  the  insane. 

XIV.  All  persons  employed  in  the  care  of  the  insane  should  be  active, 
vigilant,  cheerful,  and  in  good  health.  They  should  be  of  a  kind  and 
benevolent  disppsiti on;    be  educated,  and   in   all  respects  trustworthy; 


144 

and  their  compensation  should  be  sufficiently  liberal  to  secure  the  ser- 
vices of  individuals  of  this  description. 

COMMENTS    ON   KIRKBRIDE's   VIEWS  * 

The  foregoing  views  of  Doctor  Kirkbride  on  some  of  the  most  impor- 
tant of  the  many  subjects  connected  with  hospitals  for  the  insane,  their 
location,  site,  and  organization,  should  be  carefully  considered.  No 
man  in  America  is  better  or  more  favorably  known,  and  but  few  have 
had  so  successful  a  career  or  so  large  an  experience.  His  opinions  have 
been  accepted  by  all  as  the  best  authority,  and  if  not  always  concurred 
in,  certainly  always  command  attention.  If  we  have  imbibed  some  of 
his  ideas  it  may  not  be  regarded  as  strange  or  unexpected,  since  they 
are  supported  by  reason  and  confirmed  by  experience.  Others  more 
experienced  and  able  than  we  are  have  done  likewise.  If  we  differ  with 
him  on  some  points  of  importance,  it  is  because  other  men  of  ability 
have  impressed  us  with  their  views,  and  our  observations  have  led  us  to 
different  conclusions.  We  think,  for  instance,  that  no  Board  of  Trustees 
for  the  management  of  an  asylum  should  consist  of  more  than  seven 
members — five  being  still  better  than  seven.  Small  Boards  seem  to  be 
more  efficient  than  large  ones.  They  do  not  leave  matters  so  much  to 
each  other,  and  thus  neglect  their  duties.  We  believe  that  detached 
buildings  for  the  purposes  ^that  w^e  have  suggested  are  desirable  features 
in  an  asylum;  he  does  not.  But  in  most  of  his  views  we  heartily  concur, 
and  only  regret  they  are  not  as  well  known  by  the  people  as  by  the 
profession.  Let  us  hope,  at  least,  that  they  may  be  carefully  w^eighed 
and  duly  considered  by  our  legislative  committees  and  Boards  of  Com- 
missioners. The  subjects  of  ventilation,  warming,  lights,  water  closets, 
comparisons  between  the  asylums  of  different  countries,  and  many  other 
matters  of  more  or  less  interest,  have  been  so  completely  and  minutely 
noticed  and  discussed  by  Doctor  Manning,  and  his  conclusions  ordina- 
rily so  just  as  to  challenge  our  approval  on  most  subjects,  that  we  are 
induced  to  incorporate  the  following  sketch  of  his  able  and  interesting 
report  into  our  own. 


CHAPTEE  X. 
INSANE  ASYLUMS— DOCTOR  MANNING'S  REPORT. 

Synopsis  of  Doctor  Manning's  Report— Comments  upon  the  same. 
SYNOPSIS    OF   DOCTOR    MANNING'S    REPORT. 

Doctor  Manning  commences  his  report,  made  in  eighteen  hundred  and 
sixty-seven,  to  the  Government  of  New  South  Wales,  by  considering 
briefly  the  various  existing  methods  of  providing  for  the  insane,  which 
he  divides  into  five  classes: 

1st.  Indigent — supported  mainly  or  wholly  by  local  or  General  Gov- 
ernment. 

*  N5te.— Sefe  Kirktridfe  on  Ho'sp'itals  for  thfe  Insane. 


145 

2d.  Non-pauper — supported  bj  friends  or  from  their  own  estates. 

3d.  Criminal. 

4th.  Idiots. 

5th.  Inebriates. 

He  spealvs  first  of  the  provision  made  for  them  in  private  dwellings^ 
especially  in  England,  Scotland,  France,  and  Belgium;  thinks  that  even 
in  Scotland,  where  there  are  peculiar  advantages  (from  the  character 
and  sparseness  of  population)  for  this  method  of  treatment,  the  fact  that 
the  number  of  insane  thus  accommodated  has  steadily  diminished  since 
the  visitations  of  the  Board  commenced,  is  worthy  of  note;  and  alludes 
to  the  evils  of  this  method  (see  p.  9).  Li  a  neiv  country  such  a  plan  is 
altogether  irnpracticahle.     Describes  Gheel  (pp.  9  to  14). 

Next  treats  upon  farm  asylums,  and  describes  Clermont  (p.  15),  and  in 
conclusion  says:  "A  full  examination  of  the  system  of  farm  asylums 
shows  that  it  is  economical,  and  calculated  to  promote  the  comfort  and 
happiness,  and  be  beneficial  to  the  mental  health  of  the  inmates." 

Next,  close  asylums;  speaks  of  the  poorhouse  wards,  and  quotes  from 
Doctor  Willard,  of  their  miserable  condition  in  the  United  States;  then 
contrasts  them  with  the  State  asylums;  considers  it  "remarkable  that 
proprietary  asylums  for  pauper  patients  are  unknown  in  America." 

Page  22 — Describes  general  construction  and  organization  of  asylums 
for  paupers.  •  ^ 

1.  Elevation  of  position; 

2.  Aspect; 

3.  Distajice  from  town. 

Table  of  amount  of  land  owned  and  cultivated  by  several  asylums,  p.  25. 
Before  treating  of  asylum  construction,  considers  the  two  questions: 

1.  Separation  of  the  acute  and  chronic  cases; 

2.  The  size  of  asylums. 

Arguments  for  and  against  separation  are  presented  on  pages  twenty- 
eight  to  twenty -nine.  Dr.  Manning  says  :  "  Upon  the  whole,  it  must  be 
considered  that  the  balance  of  argument  is  strongly  in  favor  of  one  asy- 
lum, to  contain  both  classes  in  such  proportion  as  they  occur  in  each 
district." 

In  regard  to  size,  he  says:  "  For  the  new  institutions  on  the  continent, 
wherever  placed,  the  maximum  number  is  fixed  at  six  hundred;  and  in 
many  cases  a  much  smaller  size  is  preferred;"  then  presents  two  tables 
(p.  30)  of  asylums  in  England  and  of  a  few  in  Scotland,  France,  Ger- 
many, and  United  States,  showing  number  of  patients  and  rate  of  main- 
tenance. 

Treats  of  Construction  under  four  heads: 

Form  of  building; 

Number  of  stories; 

Material; 

Architecture. 

Form — 1.  Corridor,  or  ward  form; 

2.  House  form; 

3.  Block,  or  pavilion  form; 

4.  Cottage  form. 

His  objections  to  the  corridor  form  are  "that  the  asj^lum  is  spread  over 
an  immense  area,  is  costly  in  construction  from  the  immense  length  of 
corridor  and  roofing  required,  and  from  the  absence  of  all  those  social 
and  domestic  arrangements  which  characterize  an  English  home." 

19 


146 

The  advantages  of  the  house  form  are  "that  the  condition  of  the 
patient  is  assimilated  to  that  of  ordinary  life  by  the  separation  of  the 
sleeping  accommodation  from  that  required  for  the  duties  and  employ- 
ments of  the  day,  the  supervision  of  the  j^atients  by  the  attendants  is 
more  complete,  ventilation  is  more  easy,  since  the  windows  and  doors 
of  the  sleeping  rooms  from  which  the  j^atients  are  removed  can  be  kept 
fully  open  all  day,  and  those  of  the  day  rooms,  all  night;  whilst  the 
cleaning,  always  a  matter  of  difficulty  in  the  ward  plan,  is  rendered  easy 
from  the  fact  that  the  floors  are  in  use  at  different  times." 

The  block  or  pavilion  plan  is  "  a  still  further  development  of  the  house 
plan." 

"  As  supplementing  an  ordinary  asylum,  the  cottage  system  has  worked 
admirabl}^,  but  when  fully  employed  the  system  has  not,  on  the  whole, 
been  found  to  answer.  The  inconveniences  which  have  been  felt  in  this 
arrangement  have  been  chiefly  from  difficulties  of  supervision  owing  to 
the  large  space  over  which  the  asylum,  extends.  The  best  form  of 
cottages,  whether  for  a  complete  asylum  or  as  adjunct  to  an  existing 
institution,  are  the  '  conjoined  cottages  '  designed  by  Mr.  Stack  and 
Doctor  Campbell,  at  the  Essex  Asylum,"  (see  p.  33  for  description,  and 
App.  G,  Nos.  10  and  11  for  plans.) 

Page  34 — Water  supply.     This  inquiry  includes: 

1.  The»source  and  mode  of  supphj; 

2.  Quantity; 

3.  Storage; 

4.  Precaution  against  fire. 

As  supplementary  to  this  question  are  considered  arrangements  for 
the  cleanliness  of  patients: 

1.  Baths; 

2.  Lavatories; 

3.  Sinks; 

Their  situation,  material  and  fittings,  and  their  number.  The  propor- 
tion of  baths  in  English  and  American  Institutes,  about  one  to  twenty 
patients;  on  the  Continent,  less. 

Page  38 — Drainage. 

Page  45 — Warming,  by: 

1.  Open  fires; 

2.  Hot  air; 

3.  Hot  water; 

4.  Steam. 

Page  47 — Lighting: 

1.  Windows; 

2.  Lamps. 

Examining  windows  is  noted: 

1.  Position  and  proportion  to  wall  space: 

2.  Material  and  jnethod  of  opening; 

3.  Size  of  panes; 

4.  Guards  and  accessories,  as  shutters,  etc. 

Page  52 — Ventilation,  either  artificial — by  propulsion  or  extraction;  or 
natural — by  doors,  windows,  and  fireplaces  only,  or  by  oj^enings  in  addi- 
tion to  these. 

Doctor  Manning  says;  "it  is  noteworthy  also  that  those  with  windows, 
doors,  and  fireplaces  only,  and  those  with  the  more  simple  accessories  in 
addition  to  these,  seem  as  well  ventilated  as  those  in  which  there  is  an 
elaborate  arrangement  of  ventilating  shafts." 


147 

Page  54 — Cubic  space. — In  the  new  asylum  at  Madras  fifteen  hundred 
cubic" feet  is  the  space  fixed  for  European  patients. 
Day  and  night  accommodation: 

1.  Bay  or  sitting  rooms. 

2.  Dining  rooms. 

3.  Dormitories. 

4.  Airing  grounds. 

Considers  the  question  of  single  rooms  or  common  dormitories  quite  an 
important  one.  It  is  universally  agreed  that  violent,  noisy,  dirty 
patients  should  be  accommodated  in  single  rooms,  but  it  by  no  means  is 
decided  what  proportion  of  patients  it  is  necessary  to  isolate  thus. 

Page  59 — Floorings,  Jittings,  and  furniture  of  rooms. 
'  Page  64 — Staircases  and  stairs,  bells. 

Page  65 — Treats  of  the  different  i^rovisions  made  in  asylums  for  con- 
valescents and  quiet  patients,  for  the  sick  and  infirm,  and  for  the  violent  and 
excited.  "  The  j^roportion  of  violent  patients  for  which  provision  is  gen- 
erally made  would  appear  to  be  about  one  tenth." 

Kitchens,  laundry,  chapel,  dead-house  and  cemetery,  amusement  room, 
library,  are  each  considered  separately  in  turn,  followed  by  a  brief 
notice  of  the  provision  made  for  employes  of  all  classes. 

Page  75 — Organization  and  government,  which  Dr.  Manning  considers 
"even  of  greater  importance  than  asylum  construction;"  reviews  briefly 
the  method  in  use  in  different  countries,  and  concludes: 

"On  examining  closely  the  general  condition  of  asylums,  those  are 
almost  always  found  to  be  best  managed  in  which  the  physician  is  the 
Superintendent,  one  and  supreme;  in  which  the  committee  of  visitors  act 
only  through  him  and  with  his  advice,  and  in  which  the  appointment 
and  dismissal  of  all  attendants  are  delegated  to  him;  and  those  are  found 
to  be  least  satisfactory  in  which  the  responsibility  is  divided;  in  which 
the  committee  of  visitors  or  controlling  Board  meddle  in  the  internal 
management  of  the  institution,  and  direct,  themselves  or  through  other 
officers,  any  ^^vt  of  it,  appoint  or  dismiss  attendants,  or  clip  in  any  way 
the  authority  of  the  Medical  Superintendent." 

Page  80 — Gives  a  table  of  the  salaries  of  Superintendents  in  some 
English  asylums  and  the  number  of  assistants. 

Then  follows  a  consideration  of  each  of  the  classes  of  subordinate 
employes. 

Page  84 — Table  of  proportionate  number  of  attendants  to  patients  in 
the  principal  asylums  of  England,  France,  Germany,  Holland,  and  the 
United  States.  Ages  of  attendants  (in  English  asylums),  from  eighteen 
to  thirty-five;  generally  deemed  advisable  that  they  should  not  be  under 
twenty-one.  Discusses  the  desirability  of  placing  attendants  in  uniform, 
but  expresses  no  decided  oj^inion.  Diet  of  attendants  and  the  privileges 
allowed  them  follows. 

Page  88 — Artisans  and  servants. 

Page  91 — Hospital  dietary,  followed  by  considerations  as  to  clothing 
of  patients;  next,  labor — several  tables  relative  thereto  being  given; 
then  follows  amusement  and  school;  classification  of  patients;  animals 
kept  at  asylums;  system  of  supply  (commissariat);  provision  for  relief 
of  patients  on  discharge;  asylum  reports. 

Page  108— Statistics. 

Page  116 — Eestraint  and  seclusion. — Doctor  Manning  quotes  from 
Doctors   Bucknill,  Wilkes,   Ewerts,  Meyer,   Kirkbride,  and   Gray,  and 


148 

shows  the  practice  in  many  asylums.  lie  says:  '-'During  the  last  few 
years  there  has  been  a  certain  reaction  in  the  feelings  of  Superintendents 
of  asylums  on  this  subject.  In  quite  half  of  the  asylums  visited, 
although  restraint  was  not  practiced,  its  advantage  in  certain  cases  was 
distinctly  admitted,  and  it  does  not  now  meet  with  the  all  but  wholesale 
condemnation»which  was  accorded  to  it  some  few  years  ago."  After 
sj^eaking  of  the  use  of  the  shower  bath,  lie  concludes  as  follows: 

"  It  is  not  a  little  curious  that  owing  more  or  less  to  popular  clamor, 
and  to  a  fear  of  the  abuses  to  which  they  are  liable,  mechanical  restraint 
has  been  virtually  abandoned  in  Great  Britain,  and  the  shower  bath  has 
ceased  to  be  used  in  America,  and  so  a  mode  of  treatment  useful  in  a 
certain  number  of  cases  is  lost  to  the  physician  in  each  country." 

Page  122 — Accommodation  for  patients  paying  for  their  maintenance. 
Page   125 — Criminal  lunatics;  which  are  divided  into  two  classes: 

1.  Those  who  whilst  insane  commit  criminal  acts. 

2.  Those  who  become  insane  v\'hile  undergoing  punishment. 

He  treats  of  the  distinction  made  between  these  classes  and  the  man- 
ner in  which  they  are  provided  for;  thinks  that  Scotland  is  broader  in 
principle  and  has  been  more  successful  in  her  treatment  of  this  class; 
then  describes  at  considerable  length  the  Broadmoor  Criminal  Asylum 
and  the  Criminal  Lunatic  Asylum  at  Perth,  Scotland. 

Page  139 — Asylum  for  idiots. 

Page  148 — Asylum  for  inebriates. 

Page  154 — Suggestions,  from  which  are  quoted  the  following  para- 
graphs: 

"  The  moral  and  material  advantages  which  follow  the  system  of  ]}yo- 
vision  for  the  insane  in  private  dwellings  are  undoubted." 

"  It  is  necessary  that  population  should  so  increase  as  not  only  to 
form  aggregate  bodies,  towns,  and  villages,  but  to  form  a  united,  related, 
fixed,  and  settled  people;  and  that  the  masses  shall  have  received  a  cer- 
tain education  on  lunatic  matters,  by  j^ublic  papers  and  by  the  existence 
of  well  conducted  asylums,  before  the  separate  system  is  adopted.  An 
attemj)t  to  place  any  large  number  of  the  insane  in  private  dwellings 
must  necessarily  fail  in  a  new  country,  colony,  or  State.  Neither  the 
Belgian  system  nor  the  Scotch  is  possible  in  Nevv^  South  AYales  at  present, 
but  the  advantages  of  these  should  be  ever  kept  in  view,  and  the  whole 
asylum  organization  should  tend  towards  the  development  of  such  sys- 
tems in  the  maturer  age  of  the  colony." 

"  The  close  asylum,  however,  has  been  in  long  years  past,  and  must  be 
in  the  years  yet  to  come,  the  chief  method  in  which  the  insane  of  all 
countries,  in  the  acute  stages  of  their  maladies,  are  provided  for." 

Page  157 — Doctor  Manning  quotes  from  Doctor  Wilson,  the  Catholic 
Bishop  of  Ilobart  Town,  in  reference  to  locating  a  hospital  near  a  large 
city,  as  follows: 

"  The  advantages  of  having  a  hospital  near  a  large  city  are  incalcula- 
ble.    Here  are  a  few: 

"  1.  The  securing  judicious  visitation  of  a  properly  selected  Board  of 
Commissioners  for  the  general  management  of  so  important  an  institu- 
tion, a  measure  absolutely  necessary  for  its  permanent  well  working. 


149 

"2.  The  means  of  procuring  the  best  medical  and  surgical  assistance 
when  required. 

'^3.  The  opportunity  afforded  almost  daily  to  convalescent,  quiet,  and 
orderly  patients  of  visiting  the  city  for  amusement,  going  through  the 
markets,  sometimes  strolling  through  the  public  pleasure  grounds,  and 
obtaining  that  change  so  beneiicial  to  them,  both  mentally  and  phy- 
sically. 

"4.  Affording  facility  to  humane  and  well  qualified  persons  of  grati- 
fying in  the  asylum,  not  unfrequently  of  an  evening,  patients  whoso 
minds  are  in  a  state  to  profit  by  such  kind  ofi^ccs,  with  music,  instru- 
mental and  vocal,  recitations  of  short  and  cheerful  pieces,  or  appropriate 
readings,  and  such  like  friendly  acts. 

"5.  Of  affording  patients  likely  to  profit  by  such  visits  the  means  of 
attending  such  public  exhibitions  in  the  city  as  ofter  from  time  to  time 
suitable  for  them.     Many  other  advantages  might  be  mentioned." 

On  page  one  hundred  and  sixty-six  Doctor  Manning  says: 

"  The  site  to  be  chosen  for  an  asylum  is  a  matter  of  primary  impor- 
tance. On  it  must  depend  in  no  small  degree  the  comfort,  happiness, 
and  health,  both  mental  and  bodil.y,  of  the  inmates,  as  well  as  the  cost  of 
the  institution  and  the  whole  work.ng  of  its  internal  economy. 

"An  elevated  position  is  desirable,  because  more  healthy — command- 
ing, as  a  rule,  more  extended  views,  both  from  the  rooms  and  airing 
grounds,  and  aftbrding  greater  facilities  for  drainage  and  ventilation. 

"In  the  suggestions  and  instructions  to  architects,  issued  by  the  Com- 
missioners for  England  and  Scotland,  it  is  suggested  that  'it  should  not 
be  near  to  any  nuisances,  such  as  steam  engines,  shafts  of  mines,  noisy 
trades,  and  offensive  manufactories;  neither  should  it  be  surrounded,  or 
overlooked,  or  intersected  by  public  roads  or  footpaths;'  'that  the  site 
of  the  building  should  be  elevated  as  respects  the  surrounding  country, 
and,  if  to  be  obtained,  undulating  in  its  surface  and  having  a  fall  to  the 
south.'  " 

Doctor  Manning  con^nues: 

"The  subsoil  should,  if  possible,  be  calcareous,  gravelly,  or  rocky; 
but  if  the  position  is  elevated  and  the  drainage  good,  a  clayey  subsoil, 
such  as  is  occupied  by  more  than  one  of  the  best  English  asylums,  is  not 
objectionable." 

The  advantages  to  be  derived  from  proximity  to  a  large  town  are: 

1.  Facility  of  access  for  patients  and  their  friends,  Commissioners,  Inspec- 
tors, and  other  Government  ojficials,  medical  officers,  etc. 

2.  Diminished  cost  of  conveyance  of  coed,  stores,  and  provisions. 

3.  Facility  for  amusement  of  patients. 

4.  Supply  of  gas  and  water. 

5.  Increased  facilities  for  procuring  good  attendants  and  for  inducing  them 
to  remain  for  a  longer  time. 

The  special  need  of  the  attendants  (who  are  always  with  the  insane) 
for  change  and  amusement  away  from  the  institution  is  sj^oken  of  at 
considerable  length. 

In  reference  to  land,  Doctor  Manning  recommends  "  the  j^roportion  of 


150 

one  acre  to  every  two  patients,"  "instead  of  the  minimum  of  one  acre 
to  every  four  patients,  suggested  by  the  British  Commissioners."  "  The 
full  amount  which  will  be  required  for  the  institution,  according  to  its 
estimated  eventual  extent,  should,  if  possible,  be  acquired  at  once.  It 
might  either  be  cultivated  by  the  patients  in  the  institution,  if  sufficiently 
numerous  for  the  purpose,  partly  cultivated  by  hired  labor,  or  let  on 
short  lease  till  the  number  of  patients  was  sufficient  to  work  it;  but  as 
much  as  possible  of  it  should  be  brought  under  cultivation — fruits,  root 
or  cereal  crops,  grown  according  to  the  nature  of  the  soil,  the  wants  of 
the  institution,  and  the  capabilities  of  the  inmates.  The  more  an  asylum 
is  self  supporting  in  this  respect  the  greater  will  be  the  economy  of 
expenditure. 

''It  has  been  calculated  that^the  labor  of  the  insane  is  only  equal  to 
one  fifth  of  that  of  the  sane,  so  that  one  hundred  patients  are  equivalent 
only  to  twenty  healthy  field  laborers.  In  most  asylums  there  will  be 
found  one  inmate  in  every  five  suitable  for  field  labor,  so  that  in  an  asy- 
lum of  five  hundred  patients,  there  will  be  about  one  hundred  inmates 
capable  of  such  employment.  But  if  it  is  supposed  that  only  half  this 
number  c.  n  be  so  employed,  it  will  be  equivalent  to  the  constant  labor  of 
ten  healthy  men;  and  what  these  are  caj^able  of  eftecting  in  agriculture 
and  horticulture  can  be  estimated  by  all  those  conversant  "with  the 
matter." 

In  regard  to  the  question  of  the  separation  of  acute  and  chronic  cases, 
Doctor  Manning  says:  "The  solution  of  this,  like  many  other  practical 
questions  regarding  asylums,  depends  very  much  upon  the  population 
of  the  district,  upon  the  nature  of  the  existing  buildings,  and  upon  the 
special  aims  which  it  is  intended  to  combine  with  their  erection  (e.  g., 
clinical  instruction).  Wherever  a  large  population  is  crowded  within  a 
small  space,  and  two  asylums  can  be  made  fairly  accessible  to  the  whole 
population  of  the  district,  the  greatest  argument  against  the  separation 
of  acute  and  chronic  cases  ceases  to  exist." 

In  regard  to  the  size  of  asylums.  Doctor  Manning  quotes  the  opinions 
expressed  by  many  eminent  authorities,  and  concludes  as  follows: 

"  Weighing  well  all  the  opinions  of  eminent  men  on  this  subject,  and 
the  arguments  with  which  they  are  backed,  and  judging  from  personal 
inspection  of  existing  asylums,  the  opinion  may  be  expressed  that  from 
four  to  five  hundred  is  the  preferable  size  for  an  asylum,  and  that  six 
hundred  should  never  be  exceeded.  The  asylums  which  are  vv^orking 
smoothly  and  well,  with  every  care  for  the  treatment  of  patients,  and 
effective  supervision,  are,  as  a  rule,  below  this  number;  and"  "for  eco- 
nomical reiisons,  from  four  to  five  or  six  hundred  is  the  preferable  number. 
The  maintenance  rate  generally  increases  where  the  population  is  below 
or  above  it." 


151 


Table, 


Giving  a  List  of  certain  American  and  European  Asylums,  with  the  Amount 
of  Land  about  them  and  the  Amount  used  for  Pleasure  Grounds  {Airing 

Courts  included). 

[Manning's  Report.] 


ASYLUM. 


Acres  of 
Land. 


Pleasure 
Ground. 


100 

200 

96 

252 

150 

150 

80 

100 

96 

80 

100 

77 

40 


Worcester  County 

Sussex  County 

Essex  County 

Three  Counties 

New  Surrey 

Middlesex  County  (Colney  Hatch) 

Gloucester  County 

Derby  County 

Lancashire  County 

Leicester  County 

Stafford  County  (New) 

Stafford  County  (Old) 

Lincoln  County ' 

Bristol  Boroui^h ;       32 

Cotton  Hill  Lunatic  Hospital |       80 

Northampton  Hospital |       '^5 

Eetreat,  York |       30 

Elgin  District  Hospital '       92 

Perth  Hospital ^ |       60 

Haddington  Hospital 12 

Fife  Hospital ^57 

Montrose  Royal 

Government  Asylum,  Washington 

Pennsylvania  State 

Northampton  (Mass.)  State 

New  Jersey  State 

New  York 

Evreux,  Departement  Eure 

Quatre  Mares,  Departement 

Seine  In ferieure 

Sainte  Anne,  Departement  Seine..., 
Yille  Evrard,  Departement  Seine... 

Yancluse,  Departement  Seine 

Colony  of  Fitz  James,  at  Clermont 


110 
230 
130 
200 
120 
200 
150 
100 

*'l4 

750 

700 

1000 


Meerenberg,    HoUan d |       70 

Guislain's  Asylum,  Ghent 

Hamburg 

Illenau 

Frankfort 

Gottingen 


35 
65 
42 

40 
20 


152 


Table, 


Shoirlng  Number  of  Fatients  and  Assistants  in  certain  Asylwns,  with  the  Sala- 
ries of  the  Superintendents  in  certain  of  the  English  and  Scotch  Asylums. 

[From  Manning's  Eeport.] 


II 

:  '5 


Bristol 

Derby 

Leicester 

Stafford 

liincoln 

Sussex 

Three  Counties 

Worcester 

Essex 

Gloucester 

]S"ew  Surrey 

Lancashire,  Lancaster 
Lancashire,  Prestwich 

York,  West  Eiding 

Colney  Hatch 

Perth  District 

Cupar 

Montrose 


206 
342 
391 
469 
502 
510 
534 
540 
554 
590 
650 
836 
962 
1,124 
2,026 
220 
213 
380 


1  ;£500 

1  


1   I  650 

1   I  550 

1  550 

1  600 

1  I  800 

2  I  500 

1  i  600 

2  ;  600 
2  1  750 

9 


2   i  600 

1  I  350 

1  300 

1  400 


Quatre  Mares 

St.  Yon 

St.  Anne 

Ville  Evrard 

Evreux 

Guislain's  Asy.,  Ghent 

Meerenberg 

Hamburg 

Frankfort 


Gottingen 


Illenau 

;  I  Washington 

Xew  Jersey  State 

Pennsylvania  State.... 

Northampton 

New  York  State 


715 
950 
600 
600 
500 
450 
600 
350 
200 
300 
450 
380 
500 
380 
420 
608 


CONSTRUCTION, 


•  To  make  the  lunatic  as  much  "  at  home  "  as  possible,  to  make  the 
household  arrangements  of  an  asylum  resemble  those  of  a  large  private 
dwelling  house  so  far  as  is  consistent  with  salubrity  of  structure,  economy 
of  expenditure,  and  facility  of  supervision  and  management,  should  be 
the  leading  j^rinciple  in  the  construction  and  internal  arrangements  of 
asylums. 

Asylum  construction  must  depend  somewhat  on  the  classification  of 
the  patients  which  is  considered  necessary. 

The  classification  recommended  is: 

1.  Becent  cases. 

2.  Sick  and  infirm. 

3.  Violent  and  noisy. 

4.  Ordinary  patients. 

In  an  asylum  for  five  hundred  patients,  at  least  six  divisions  for  each 
sex  are  necessary;  and  in  this  case  the  "ordinary"  patients  may  be 
placed  in  two  divisions;  but  with  a  smaller  number,  three  or  four  will 


153 

suffice;  the  "recent"  and  "ordinary"  cases  being  amalgamated  or  not. 
Thirty  to  forty  patients  are  a  sufficient  average  number  for  each  division. 

For  a  small  aeylum  the  maximum  population  of  which  is  never  to 
exceed  two  hundred,  the  modified  cottage  plan  is  the  one  to  be  most 
recommended. 

For  an  as^dum  built  originally  for  one  hundred  and  fifty  or  two  hun- 
dred patients,  but  intended  for  enlargement,  so  as  eventually  to  contain 
four  hundred,  the  "  house  "  plan  or  the  pavilion  2)lan  are  most  fitted  for 
the  original  structure. 

For  an  asylum  built  originally  to  contain  five  hundred  patients  in  six 
divisions,  the  pavilion  or  block  plan  ma}^  be  mainly  adopted  and  supple- 
mented by  cottages;  or  plans  may  be  so  modified  as  to  embrace  the 
house,  pavilion,  and  cottage  plan,  blended  into  one  harmonious  whole,  as 
in  the  New  Surrey  Asylum.* 

If  the  three  plans  are  combined  to  form  one  asylum  the  two  classes 
who  require  most  constant  care  and  attention  (the  sick  and  the  acute 
cases  recently  admitted)  should  be  placed  in  the  part  built  on  the 
"house"  plan,  which  will  be  under  one  roof  with  the  administrative 
department,  and  so  within  easy  access  of  the  Resident  Physician. 

The  ordinary  patients  and  the  violent  class  may  be  placed  in  detached 
blocks,  two  or  three  in  number  for  each  sex;  and  the  small  asylum  town 
thus  built  be  supplemented  by  cottages  for  idiotic  and  convalescent 
patients. 

The  cottage  plan  is  particularly  fitted  for  patients  of  good  education. 
It  adds  vastly  to  their  comfort  to  separate  them  from  the  other  inmates. 
For  convalescent  patients  also,  the  association  with  sane  people  is  very 
beneficial,  and  they  by  this  means  are  allowed  greater  liberty,  and  are 
able  to  resume  gradually  their  accustomed  life,  instead  of  j^assing  at 
once  from  the  asylum  ward  and  its  artificial  existence  to  the  realities  of 
actual  life  abroad. 

The  special  block  for  violent  and  noisy  patients,  which  should  be  the 
smallest  division  of  the  house,  should  have  connected  with  it  and  open- 
ing from  it,  a  one-storied  building,  capable  of  containing  four  or  five 
patients.  It  should  consist  of  corridor  and  single  rooms,  and  should 
have  one  or  more  small  airing  courts,  opening  either  from  the  corridor 
or  the  rooms. 

The  question  as  regards  the  number  of  stories  in  an  asylum  must 
depend  chiefly  on  the  uses  to  which  the  rooms  on  the  ground  floor  are 
applied.  If  the  ground  floor  is  to  be  divided  into  day  room  and  dining 
rooms,  and  so  the  patients  occupy  only  half  of  it  at  once,  the  number 
for  which  it  will  serve  will  not  be  greater  than  can  be  contained  in  one 
dormitory  floor;  but  if  the  dining  room  accommodation  is  2')rovided  else- 
where, the  space  for  sitting  or  day  room  accommodation  will  be  doubled, 
and  made  sufficient  for  the  number  of  patients  who  can  be  accommodated 
in  two  stories  built  over  it.  The  sj^ace  required  for  sitting  and  day 
room  in  asylums  is  reckoned  to  be  about  half  that  required  for  the 
night. 

The  material  to  be  selected  for  asylam  construction  may  fairly  be  that 
which  is  most  readily  procurable,  so  long  as  it  is  durable  and  not  porous. 
So  long  as  the  windows  are  of  large  size,  the  particular  style  may  fairly 
be  left  to  the  architect  entrusted  with  the  planning  of  the  building. 

A  full  supply  of  pure  water  is  an  important  requisite  in  an  asylum, 

*  See  Appendix  F,  plates  5,  6,  7. 
20 


154 

and  no  site  should  be  chosen  where  this  cannot  be  obtained.  If  the 
as^'lum  be  near  the  town,  the  town  supj^ly  will  be  found  cheaper  and 
altogether  more  convenient  than  any  other  arrangement;  but  when  at  a 
distance,  the  supply  from  a  well  or  spring,  especially  if  this  is  close  to 
the  buildings,  is  the  best  method,  since  the  steam  engine  which  will 
always  be  necessary  to  pump  and  fill  tanks,  may  be  made  to  serve  other 
purposes  also,  as  turning  machinery,  either  at  the  laundry  or  farm  build- 
ings, whilst  the  boilers  which  supply  it  may  be  used  also  for  heating  hot 
water  for  baths  and  lavatories,  the  kitchen  and  laundry.  No  supply 
from  a  running  stream  should  be  used  without  careful  filtration,  and  if 
water  is  procurable  in  any  other  way,  surface  drainage  should  not  be 
resorted  to,  since,  with  this  method  in  use,  high  farming  is  almost 
impossible,  without  running  risk  of  dire  illness  to  the  inmates  from 
animal  poison  contained  in  the  water.  The  quantity  required  for  the 
use  of  an  asylum,  even  when  earth  closets  are  used,  is  not  less  than 
fifteen  to  twenty-five  gallons  per  head  j)er  diem. 

For  safety  in  case  of  fire.  Dr.  Manning  says:  "Eelianr-e  should  be 
placed  mainly  on  hydrants,  for  which  proper  hose  should  be  kept  always 
at  hand,  placed  both  outside  in  the  grounds  and  inside  on  the  staircases. 
These  should  be  connected  both  with  the  ordinary  water  supply  and 
with  the  tank;  and  where  a  steam  engine  exists,  the  pipes  should  be  so 
arranged  that  the  water  may  be  played  by  steam  power.  Fire  drill,  at 
w^hich  attendants  and  patients  should  assist,  should  be  practised  at  fixed 
intervals,  and  the  hose  and  other  aj^pliances  kept  always  in  order.  In 
asylums  in  which  force  of  water  sutficient  to  play  the  hose  cannot  be 
obtained,  ordinary  hand  fire  engines  should  be  kej)t  at  the  asylum,  and 
the  patent  contrivance  called  'L'Extincteur '  may  be  also  kept  at  hand." 

Every  asylum  should  be  lighted  throughout  with  gas,  which  is  at 
once  the  safest,  cheapest,  and  most  eftective  mode  of  lighting.  If  gas 
cannot  be  conveniently  obtained  from  a  company's  works,  it  may  be 
made  on  the  premises  without  difiiculty,  at  a  cost  which  will  render  it 
cheaper  than  any  other  kind  of  illumination  such  as  it  is  necessary  to 
have  in  an  asylum. 

Dr.  Manning  gives  it  as  his  opinion  that  open  fireplaces,  especially 
when  built  with  air-chambers,  as  in  use  in  English  asylums,  form  the 
best,  simplest,  and  cheapest  mode  of  warming  asylums  in  a  moderately 
cold  climate;  but  in  America  the  elaborate  system  of  heating  by  steam, 
which  has  been  almost  universally  adopted,  is  perhaps  the  best  which 
could  be  used. 

Natural  ventilation,  with  such  accessories  as  may  be  deemed  expe- 
dient— and  the  simpler  these  are  the  better — can  alone  be  recommended 
for  an  asylum  in  a  temperate  climate. 

The  height  of  twelve  feet,  proposed  by  the  American  Association  of 
Medical  Superintendents,  seems  ample  for  all  the  purposes  of  an  asylum 
room. 

Every  room  should  have  its  cubical  contents  painted  on  its  door. 

In  all  asylums  separate  day  and  diningroom  accommodation  should 
be  provided.  It  will  be  well  that  one  diningroom  should  be  provided 
for  each  sex,  and  that  they  should  be  placed  on  each  side  of  the  kitchen. 
Day  room  accommodation  should  be  provided  for  each  section  of  the 
asylum,  at  the  minimum  rate  of  five  hundred  cubic  feet  for  each  person. 
A  general  dining  hall,  or  two  dining  halls — one  for  each  sex — should  be 
built  conveniently  situate  with  reference  to  the  kitchen,  capable  of  con- 
taining three  fourths  of  the  entire  number  of  inmates.     Experience  has 


155 

shown  in  English  asylums  that  this  number  may  with  safety  and  advan- 
tage be  allowed  to  dine  in  common. 

Two  airing  courts  for  each  sex  are  all  that  are  absolutely  necessary 
for  an  asylum.  If  a  third  is  added  for  the  use  of  the  sick,  infirm,  and 
for  special  cases,  such  as  epilepsy,  it  will  be  found  frequently  useful.  It 
may  save  the  more  feeble  among  the  patients  from  the  accidents  which 
might  happen  to  them  in  the  large  general  court. 

In  everj"  airing  court  there  should  be  a  sunshed  and  a  verandah  or 
covered  walk,  to  afford  shade  and  allow  patients  so  inclined  to  take  exer- 
cise in  wet  weather. 

The  floorings  of  all  the  day  and  diningrooms  and  dormitories  should 
be  of  wood.  The  boards  should  be  tongued;  and  the  English  and  Scotch 
Commissioners  suggest  that  there  should  be  a  disconnection  of  the  floor 
and  joists  at  all  internal  doorways,  by  means  of  a  stone  sill.  In  all 
cases  where  a  fireproof  construction  is  not  adopted,  similar  separations, 
at  not  greater  distances  apart  than  fifty  feet,  should  be  made  in  the  floor 
and  ceilings.  There  is  but  little  necessity  for  oiling  or  j)olishing  the  floor 
except  in  rooms  devoted  to  dirt}^  j^atients. 

The  w^alls  should  be  plastered  or  cemented,  and  subsequently  painted 
or  colored  so  as  to  make  the  rooms  as  cheerful  and  bright  as  possible. 

All  rooms  devoted  to  dirty  patients  should  be  whitewashed. 

The  keys  for  the  male  and  female  side  of  the  house  should  be  different, 
and  each  attendant  provided  with  one  key  which  will  unlock  all  the 
doors  on  his  or  her  side  of  the  house.  A  sim2:)le  railway  key  will  serve 
for  each  attendant  to  turn  on  or  off'  water,  gas,  or  to  chock  the  window 
sashes,  close  or  open  shuttersi|  etc.,  so  that  each  attendant  will  have  two 
keys  only. 

Asylum  stairs  should  be  of  stone  or  iron;  the  flights  short  and 
straight.  Wooden  or  iron  handrails  should  be  provided  for  all  stairs, 
and  let  into  a  groove  in  the  wall. 

One  kitchen,  in  a  central  position,  is  all  that  is  required  for  an  asylum, 
and  in  it,  if  properly  arranged,  all  the  food  for  patients,  ofiicers,  and 
attendants  can  be  cooked. 

The  laundry  should  be  detached  from  the  main  buildings,  and  may  be 
placed  at  some  little  distance,  if  water  supply  is  thus  made  more  easy. 

The  arguments  for  a  special  chapel  in  connection  with  every  asylum 
need  not  be  repeated  here.  The  best  argument  is  the  existence  of  such 
a  cha2:>el  in  the  well  ordered  institutions  of  all  countries. 

For  minor  amusements,  the  day  rooms  of  the  institution  are  suflicient, 
but  a  room  where  the  majority  of  the  inmates  can  be  collected  for 
dances,  concerts,  theatrical  performances,  gymnastics,  lectures,  etc.,  is 
absolutely  necessary  in  an  asylum. 

It  is  scarcely  necessary  to  j^i'ovide  a  special  room  for  a  library. 

The  building  for  the  recej^tion  of  the  dead  should  consist  of  two 
rooms  at  least.  One  of  these  should  be  the  reception  room,  fitted  with 
shelves  for  the  dead,  in  which  they  may  be  seen  by  their  friends.  The 
other,  a  room  for  post  mortem  examinations,  in  which  every  convenience 
for  the  purpose  should  be  supplied — a  central  table,  hot  and  cold 
water,  etc. 

It  is  desirable  that  the  dead  should  be  buried  in  the  ordinary  cemetery 
of  the  town  or  district. 

The  balance  of  the  report  is  devoted  to  "  Organization,"  "  Dietaries," 
forms  for  asylum  reports,  and  architectural  plans. 


156 


ORGANIZATION. 


A  Board  of  Control  should  be  aj^pointed  by  the  Government  for  each 
asylum,  or  for  each  district,  and  should  consist  of  not  less  than  five 
members,  one  or  two  of  whom  should  be  medical  men,  and  the  remainder 
men  of  high  social  standing,  residing  in  the  district  in  which  the 
asylum  is  situated.  The  necessary  expenses  of  the  Board  should  be 
l^aid,  and  such  remuneration  made  to  tlie  professional  members  as  may 
be  deemed  fair,  but  the  other  members  should  not  receive  salaries,  the 
2:>osition  being  entirel}^  an  honorary  one. 

The  members  of  the  Board  may  either  retain  their  seats  permanently, 
or  one  or  two  members  may  retire  annually,  and  be  eligible  for  rea]3- 
p  ointment. 

The  duties  of  the  Board  should  be: 

1st.  The  control  of  the  finances  of  the  institution,  and  the  preparation 
of  the  necessary  estimates  for  the  consideration  of  the  Government. 

2d.  The  appointment  and  dismissal  of  all  officers,  viz:  Superintendent, 
Assistant  Medical  Officers,  Secretary,  Chaplain,  and  Housekee2:)er,  sub- 
ject to  the  aj^proval  of  the  Government. 

3d.  The  visitation  of  the  asylum  and  inquiry  into  its  management  and 
the  general  conduct  of  officers  and  attendants. 

4th.  The  inspection  of  the  forms  of  admission  sent  with  all  j^atients, 
and  the  ordering  of  the  discharge  of  all  such  as  are  recovered,  or  for 
whom  their  friends  promise  to  make  provision,  one  medical  member  of 
the  Board  being  always  present  to  examii^  the  patient  and  afiix  his 
signature  to  the  certificate  of  discharge. 

The  Board  should  also  be  charged  with  the  presentation  of  an  annual 
report  to  the  Government,  in  which  the  general  and  financial  condition 
of  the  institution  under  its  care  is  set  forth. 

On  the  appointment  of  a  Board  of  Control,  asylum  government  will 
be  thus  divided: 

Superintendence  and  Management. 

The  whole  internal  economy  of  the  asylum  will  be  under  the  contio^  of 
the  Superintendent,  and  with  him  should  rest  the  patronage,  so  far  as 
the  appointment  of  attendants  and  servants  is  concerned. 

Legislation. 

The  making  of  all  general  laws  for  the  conduct  of  the  asylum,  and  for 
the  guidance  of  all  officers  and  attendants,  will  be  the  duty  of  the  Gov- 
ernment. A  general  code  of  laws  will  serve  for  the  government  of  all 
the  asylums  of  the  country;  and  all  marked  alteration  in  such  laws 
should  be  made,  or  at  least  aj^proved,  by  the  General  Government; 
whilst  minor  alterations,  which  are  not  contrary  to  their  general  spirit, 
may  be  made  by  the  Suj^erintendent  or  Board  of  Control. 

Fina?icial  Adm inistration 

Will  be  under  the  Board  of  Control,  exact  accounts  of  the  financial  con- 
dition of  the  asylum  being  submitted  to  the  Government,  with  the  esti- 
mates for  each  year.  The  estimates  should  include  a  sum  for  incidental 
expenses,  to  be  spent  at  the  discretion  of  the  Board,  and  not  exceeded. 
(The  sum  placed  under  the  control  of  the  Board  is  fixed,  in  the  case  of 


157 

the  English  county  asylums  and  the  State  asylum,  Broadmoor,  at  four 
hundred  pounds  for  each  year.) 

Patronage. 

The  appointment  of  the  Board  of  Control  (and  the  Board  of  Inspec- 
tion, to  be  hereafter  considered)  will  rest  with  the  Government.  The 
Board  of  Control  will  appoint  all  the  officers,  who  are  immediately  re- 
sponsible to  it,  the  Government  approval  being  necessary  to  ratify  the 
appointments.  The  Superintendent  will  appoint  the  attendants  and  ser- 
vants who  come  immediately  under  his  directions. 

There  remains  to  be  considered  the  duties  of 

Inspection  and  Supervision. 

Doctor  Manning  then  speaks  of  the  way  in  which  this  is  managed  in 
the  United  States,  Great  Britain  and  Ireland,  France,  Belgium,  and  Hol- 
land, and  then  gives  his  opinion  of  wdiat  it  should  be  in  New  South 
Wales: 

The  duties  of  such  a  Board  of  Inspection  should  be: 

1st.  The  inspection  of  all  asylums,  public  and  private,  at  fixed  periods 
not  less  than  twice  a  year.  At  such  inspection  inquiry  should  be  made 
as  to  their  management;  as  to  the  regularity  of  admissions  and  dis- 
charges; thenumber  of  attendants;  the  dietary,  and  the  general  conduct 
of  the  institution. 

2d.  The  frequent  inspection  of  the  criminal  asylum,  which  it  is  recom- 
mended in  a  subsequent  part  of  this  report  should  remain  under  the 
immediate  control  of  the  Government,  without  the  intervention  of  a 
Board  of  Control. 

3d.  (Is  of  local  application,  referring  to  the''  Eeception  House  at  Dar- 
linghurst.") 

4th.  The  examination  of  all  criminal  lunatics,  either  acquitted  on  the 
gTound  of  insanity  or  found  to  be  insane,  in  prison;  and  the  direction  as 
to  their  maintenaiice  in  the  prison  for  observation,  or  their  transfer  to 
an  ordinary  or  criminal  asylum. 

5th.  The  transference  of  patients  from  one  asylum  to  another  for  any 
reasons  that  may  be  considered  good. 

6th.  The  registration,  visitation,  and  official  guardianship  of  all  luna- 
tics under  certificate  residing  with  friends  or  with  persons  paid  for  their 
maintenance,  with  power  of  inquiry  in  all  cases  of  detention  and  ill 
treatment  by  relatives  of  any  insane  person,  whether  under  lunacy  cer- 
tificate or  not. 

7th.  The  examination  of  all  certificates  in  lunacy,  to  see  that  they  are 
in  proper  form  and  that  all  necessary  particulars  concerning  the  history, 
circumstances,  social  and  mental  condition  of  the  patient  are  given. 

8th.  Inquiry  into  all  cases  of  complaints  in  asylums,  and  all  cases  in 
which  the  Lunacy  Acts  have  been  infringed. 

Super  i7itendent. 

The  Physician  of  every  asylum  should  be  Superintendent  and  chief 
executive  officer  of  the  establishment.  He  should  have  entire  control  of 
the  medical,  moral,  and  dietetic  treatment  of  the  patients;  the  power 
of  appointment  and  discharge  of  all  attendants  and  servants,  and  exer- 
cise a  general  supervision  and  direction  of  every  department  of  the  insti- 


158 

tution.  He  alone  should  be  responsible  to  the  governing  body  for  the 
state  and  condition  of  every  part  of  the  institution,  and  he  should  be  the 
recipient  of  all  their  orders. 

As$ista?it  3Iedical  Officers. 

The  Assistant  Mediciil  Officers  of  asylums  should  be  qualified  medical 
practitioners,  whose  duty  consists  in  assisting  the  Superintendent  in  the 
medical  and  general  duties  of  his  office,  and  representing  him  in  his 
absence. 

Doctor  Manning  is  of  opinion  that  "  the  medical  staff  of  an  as^dum 
containing  acute  and  chronic  cases  in  the  usual  proportion,  should  never 
consist  of  less  than  one  to  every  two  hundred  and  fifty  patients;  that 
whenever  the  asylum  poj^ulation  exceeds  two  hundred  and  fifty,  an 
Assistant  Physician  should  be  appointed;  and  that  when  the  number  of 
five  hundred  is  reached,  an  additional  assistant  is  necessary." 

COMMENTS    UPON    DOCTOR    MANNING'S    REPORT. 

We  are  of  the  opinion  that  no  asylum  should  be  without  an  Assistant 
Phvsician,  and  that  an  asylum  of  five  hundred  patients  should  be  j^ro- 
vided  with  an  additional  assistant,  as  suggested  by  Doctor  Manning.  The 
Guislain  Asylum,  as  well  as  many  others  in  the  Old  World,  are  greatly 
at  fault  in  this  respect,  and  the  bad  eftects  of  such  jjolicy  are  ever  appa- 
rent. 

AYe  have  thus  given  a  brief  sketch  of  this  exhaustive  and  admirable 
report,  and  can  only  again  express  a  regret  at  our  inability  to  obtain  a 
copy  for  the  State  Library,  and  still  hope  an  order  sent  to  New  South 
Wales,  through  Messrs.  TrLibner  cc  Co.,  Ko.  60  Paternoster  Eow,  London, 
Tn&y  succeed  in  procuring  one."^  In  most  of  the  conclusions  arrived  at 
by  Dr.  Manning,  as  well  as  suggestions  made  to  his  Government,  we 
heartily  concur.  But,  as  we  cannot  do  so  in  all,  we  deem  it  due  to  our- 
self  and  what  apj^ears  to  be  the  interest  of  the  insane  in  our  midst  to 
point  out  a  few  of  the  most  important  points  of  difference: 

1st.  For  reasons  already  stated  elsewhere,  we  think  that  tWo  hun- 
dred and  fifty  patients  as  large  a  number  as  can  be  treated  in  the  best 
jwssible  vianner  in  one  asylum,  and  that  this  number  should  never  be 
extended  beyond  four  hundred.  We  admit,  however,  that  the  practice 
•of  the  present  day  is  to  build  asylums  for  four  hundred,  five  hundred, 
and  six  hundred  patients,  as  he  has  suggested. 

2d.  We  are  satisfied  that  the  number  of  single  rooms  for  one  third  of 
the  patients  is  too  small  to  insure  the  best  results.  His  conclusions 
coincide  with  the  custom  in  Great  Britain  and  the  continental  countries, 
where  one  third  is  the  greatest  number  j^rovided  with  single  rooms,  even 
in  the  best  asylums;  whereas  we  agree  with  the  custom  in  our  own 
country,  where  the  best  asylums  are  never  provided  with  single  rooms 
for  less  than  two  thirds  of  their  patients,  and  many  of  them  a  larger 
proportion.  Under  no  circumstances  should  this  be  reduced  to  a  less 
number  than  one  half.  We  are  fully  aware  of  the  advantages  to  be 
derived  from  the  association  of  patients,  but  think  this  can  be  done 
to  best  advantage  during  the  day,  in  large  and  j^leasant  airing  courts, 
sitting  rooms,  and  pleasure  grounds. 

*  Note. — Since  the  above  was  written  the  report  of  Doctor  Manning  has  been  received, 
and  we  recommend  its  perusal  to  the  committees,  Commissioners,  and  others  especially 
interested  in  the  subject. 


159 

3d.  The  recommendation  for  six  divisions  for  each  sex,  in  an  asylum 
for  five  hundred  patients,  seems  to  be  too  small,  and  is  two  less  than 
proposed  bj  the  Superintendents  in  the  United  States;  eigl^t  divisions 
for  either  sex  is  a  better  number. 

4th.  Dining  halls  .for  three  fourths  of  the  patients  of  either  sex,  one 
on  each  side  of  the  kitchen,  does  not  commend  itself  to  our  mind  as  the 
best  method.  The  system  in  the  United  States  of  having  each  division 
take  their  meals  in  their  own  wards  is  preferred,  as  classification  is  best 
preserved  in  this  way.  Here  we  must  also  admit  that  in  all  the  asylums 
in  Great  Britain  and  on  the  continent  w4iere  we  witnessed  the  patients 
of  hospitals  taking  their  meals  in  common  dining  halls,  and  often  where 
males  and  females  ate  in  the  same  room,  no  inconveniei.ce  or  excitement 
was  observed;  but  it  must  not  be  overlooked,  that  in  all  or  nearly  all  of 
the  instances  referred  to  the  patients  were  paupers,  and  the  asylums 
almost  exclusively  occupied  by  them.  This  custom  does  not  prevail  in 
the  asylums  intended  for  the  independent  classes.  In  our  country,  all 
are  accommodated  in  the  same  asylum,  wath  very  rare  exceptions.  GDhe 
rich,  the  poor,  the  educated,  and  the  ignorant,  the  refined  and  the  vulgar, 
are  all  in  one  and  the  same  institution,  hence  greater  attention  to  classifi- 
cation and  separation  is  an  absolute  necessity. 

Separate  Asylum  for  Faiienis  who  Pay. 

Some  eminent  men  in  all  the  countries  we  have  visited  have  given  as 
their  decided  opinion,  that  ^Datients  who  pay  and  those  wiio  do  not 
should  never  be  kept  in  the  same  asylums  nor  placed  under  the  same 
administration,  as  the  privileges  that  will  be  allowed  the  one  begets 
jealousies  on  the  part  of  the  other,  w^iile  the  necessities  of  a  crowded 
asylum  often  enforces  associations  that  w^ould  not  be  recognized  at 
home,  and  with  all  the  sensibilities  sharpened  by  insanity,  as  sometimes 
happens,  disgusts  and  dissatisfactions  are  engendered,  and  detrimental 
results  the  consequence. 

What  is  best  to  be  done  and  what  can  be  done  are  two  very  difi'erent 
propositions,  and  in  a  majority  of  cases  we  have  to  accept  the  latter.  If 
it  were  possible,  ho.wever,  there  is  no  question  it  would  be  best  for  each 
State  to  furnish  one  asylum  for  the  accommodation  of  all  of  its  citi- 
zens who  desired  to  pay  for  accommodations  superior  to  those  that  can 
be  given  to  the  indigent.  These  should  be  charged  a  sufiScient  sum  to 
defray  all  the  expenses  of  such  an  establishment,  including  officers'  fees, 
repairs,  and  other  expenses,  the  State  only  furnishing  the  buildings.  All 
other  asylums  should  hQ  free  to  every  person  belonging  to  the  State  who 
might  elect  to  enter  them,  without  the  payment  oi  fee  of  any,  kind.  If 
this  system  could  be  adopted,  many  economical  changes  might  be  made 
in  the  construction  of  our  asylums,  without  detriment  to  any  class  of 
patients.  An  asylum  for  one  hundred  pay  patients  would  probably  bo 
suflEicitnt  for  all  of  this  class  now  in  our  asylum,  or  likely  to  be  com- 
mitted during  the  next  ten  years.  It  should  be  as  much  under  the  con- 
trol and  watchful  supervision  of  State  officers  as  the  others,  and  all 
charges  should  be  regulated  by  State  authority,  in  order  that  no  person 
should  profit  by  its  operations  save  and  except  the  j^atients  who  paid  for 
the  privilege  of  having  more  quiet,  more  comfort,  and  more  attention 
than  the  State  could  afford  to  give. 

This  idea,  we  fear,  is  in  advance  of  American  notions  of  propriety; 
yet  believing  it  to  be  supported  by  sound  policy,  and  with  no  injustice  to 


160 


any,  we  hope  to  see  it  carried  out  in  our  State  at  some  no  distant  period 
in  the  future.* 

5th.  The  common  bath  house  on  the  ground  floor,  one  for  each  sex,  is 
another  European  custom  adopted  in  nearly  all  asylums,  many  of  which, 
admirable  in  all  other  respects,  have  not  a  single  bath  tub  on  the  second 
or  third  floor.  This  is  certainly  a  great  defect,  and  must  suggest  many 
inconveniences  to  all  who  are  acquainted  with  asylum  management.  We 
found  in  one  asylum  in  Austria  only  one  bath  room  for  all  the  patients, 
the  men  using  it  one  day  and  the  women  the  next.  One  bath  in  four- 
teen days  was  all  that  could  be  obtained  by  each  patient.  This  asylum 
was  new,  neat,  comfortable,  and  well  managed  in  all  other  respects,  but 
the  Medical  Director  could  not  prevail  on  his  Board  of  Managers  to 
supply  even  one  other.  We  could  but  conclude  that  economy  in  this 
instance  was  a  poor  financier. 

6th.  We  cannot  see  any  special  advantage  to  accrue  from  a  law  requir- 
ing one  of  the  Board  of  Control  to  sign  certificates  of  discharge,  as  sug- 
gested by  Doctor  Manning.  Surely  the  Superintendent  must  first  say 
that  the  patient  may  be  discharged  without  detriment  ere  the  Trustee 
aflixed  his  name;  hence  it  would  only  seem  an  additional  complication 
without  corresponding  benefit.  Let  us  give  the  patient  every  protection 
and  throw  around  him  every  necessary  guard,  but  at  the  same  time 
incumber  our  rules  with  no  useless  requirements. 

With  these  few  differences  with  Doctor  Manning,  and  some  of  them 
may  be  influenced  by  prejudice  engendered  by  long  habits  of  thought 
that  observation  has  failed  to  remove,  we  most  heartily  indorse  what  he 
suggests,  and  commend  his  remarks  to  all  readers.  ^  It  has  been  our 
desire  to  present  the  ideas  and  opinions  of  others  with  quite  as  much 
freedom  as  our  own,  that  our  people  may  have  the  benefit  derived  from 
the  experience  of  many  observers. 


*  ^i^oTE.— Statement  of  the  Niiynber  and  Nativity  of  Pay  Patients  in  the  Insane  Asylum 
of  the  State  of  California,  January  1st,  1872. 


NATIVITY. 

Males. 

Females. 

Total. 

5 
4 
1 

1 
2 
3 
1 
1 
1 
1 


1 

6 

4 

1 

1 

1 

Chili                   

1 

1 

1 

1 

1 

TTnifpfl    Rtatps                                    

11 

8 

11 
3 

22 
11 

Tntnl';                                                          

19 

14 

33 

The  foregoing  table  shows  how  small  a  proportion  of  the  patients  in  our  asylum  pay  for 
their  support  and  treatment.  There  are  a  tew  others,  no  doubt,  who  would  gladly  avail 
themselves  of  asylum  care  and  the  benefits  to  be  derived  from  the  skill  and  experience  of 
its  medical  officers,  if  proper  accommodations  could  be  offered  them,  but  who  shrink 
from  the  disadvantges  and  discomforts  of  the  overcrowded  wards  of  our  asylum,  and  are 
thus  kept  at  home  till  all  hope  of  recovery  is  passed  or  the  means  of  support  have  been 
exhausted,  when  they  are  sent  to  the  asylum,  to  become  life  burdens  upon  the  Fubhc 
Treasury.  Until  the  system  suggested  can  be  carried  out,  we  think  it  would  be  iar  better 
to  abolish  all  charges,  so  far  as  they  relats  to  citizens  of  the  State. 


161 

It  is  scarcely  necessary  again  to  call  attention  to  ventilation,  warm- 
ing, lights,  water  closets,  window  guards,  flooring,  stairs,  infirmaries, 
kitchens,  laundries,  chapels,  dead  houses,  amusement  halls,  theatres, 
dances,  employes,  attendants,  airing  courts,  keys,  etc.,  as  we  have  done 
so  to  a  suflicient  extent  in  the  sketch  from  Doctor  Manning's  report,  and 
especially  as  we  must  necessarily  touch  upon  'some  of  them  in  speaking 
of  the  character  of  asylums  which  we  think  best  adapted  to  the  nature 
of  our  climate  and  the  characteristics  of  our  people. 


CHAPTEE  XI. 
CRIMINAL    INSANE. 


Another  question  connected  with  the  care  of  the  insane  should  not  be 
passed  by  without  notice.  In  England,  Scotland,  Ireland,  and  some  of 
the  contin^tal  countries,  and  in  I^ew  York,  in  this  country,  asylums 
have  been  erected  for  keeping  the*  criminal  insane  separate  from  the 
others,  and  strong  arguments  have  been  advanced  in  favor  of  the  uni- 
versal adoption  ot'this  system.    These  have  been  divided  into  two  classes: 

1st.  Those  who  have  "been  convicted  of  crime,  and  become  insane  while 
serving  out  their  sentence  of  punishment. 

2d.  Those  Avho  have  committed  criminal  acts  during  their  insanity. 

We  can  see  no  good  reason  why  those  of  the  latter  class  should  be 
deprived  of  treatment  in  an  ordinary  asylum.  In  the  eyes  of  the  law 
they  have  really  been  acquitted  of  any  criminal  intent,  and  cannot  be 
punished;  nor  should  they  be  disgraced  by  being  confined  in  an  asylum 
with  those  whose  crimes  have  led  them  to  insanity. 

With  the  first,  or  convict  class,  the  case  is  entirely  difterent.  Though 
they  have  become  insane,  and  are  thereby  entitled  to  every  consideration 
of  sympathy,  and  every  effort  at  restoration,  they  have  not  been  cured  of 
their  immoral  ideas,  low  cunning,  gross  vulgarity,  and  vicious  habits. 
On  the  contrary,  these  arc  often  whetted  by  insanity,  and  exhibited  in 
an  intensified  degree.  They  have  no  power  to  conceal  the  real  hideous- 
ness  of  theiy  character,  nor  restrain  the  debased  vulgarity  of  their  nature. 
They  are  not  only  unfit  associates  for  the  unfortunate  people  who  occupy 
the  wards  of  an  asylum,  but  have  a  detrimental  influence  upon  their 
recover}^ 

But  this  whole  subject  has  been  so  ably  and  forcibly  argued  in  the 
report  of  the  Worcester  Hospital,  we  cannot  better  bring  the  matter  to 
the  favorable  notice  of  the  Legislature  than  by  quoting  from  its  pages  : 

FROM    THE    WORCESTER   REPORT,    1862. 

Criminal  Insane. 

The  experience  of  nearly  thirty  years  operation  of  this  hosjntal,  and 
the  careful  observation  of  the  successive  Boards  of  Trustees,  of  the 
Superintendents,  and  others  engaged  in  the  management  of  this  institu- 
tion, all  go  to  establish  and  to  strengthen  their  conviction  that  it  is 
impolitic  and  wrong  to  place  insane  criminals  in  the  same  rooms,  wards, 

21 


162 

or   even   establishments   with   the   honest  and  untainted  patients,  and 
require  them  to  live  together. 

No  one  will  assert  that  the  prison  is  a  proper  place  for  a  lunatic;  and 
it  is  equally  clear  that  the  hospital,  created  for  and  occupied  by  patients 
from  general  society,  is  not  a  proper  place  for  a  criminal.  Admitting 
that  the  insane  convict  should  be  removed  from  the  one,  it  by  no  means 
follows  that  he  should  be  carried  to  the  other.  Whether  viewed  in  the 
lii^ht  of  humanity  or  of  economy,  it  is  better  that  he  be  detained  in  his 
prison  than  be  admitted  into  the  hospital,  for,  at  the  worst,  if  he  be  not 
removed,  he  may  remain  insane  for  life  for  want  of  the  means  of  heal- 
ing, while  if  he  be  placed  in  a  ward  filled  with*  other  and  respectable 
patients,  he  may  be  an  obstacle  to  their  restoration,  and  prevent  some, 
perhaps  many,  from  ever  regaining  their  health.  The  question  is  not 
simply  whether  the  insane  convict  shall  or  shall  not  have  an  opportu- 
nity of  being  healed,  but  whether  an  attempt  shall  be  made  to  save  a 
criminal  and  worthless  citizen,  by  the  peril  and  perhaps  the  sacrifice  of 
the  restoration  of  some,  possibly  many,  honest  and  valuable  men  who 
must  live  and  associate  with  him  in  the  hospital. 

Insanity  disturbs  the  mental  health  of  its  victims  in  va^ous  ways.^ 
Among  the  most  common  of  these  morbid  conditions,  is  the  exaltation  of 
sensibility,  which  makes  the  patients  timid,  anxious,  suspicious,  irrita- 
ble, and  even  sometimes  quarrelsome.  Some  are  depressed  in  spirits, 
and  almost  crushed  with  a  sense  of  imaginary  sinfulness,  or  an  int^ense 
consciousness  of  un worthiness.  To  meet  these  morbid  conditions  of  the 
patient,  the  hospital  Managers  endeavor  to  bring  the  most  favorable 
influences  to  act  upon  him;  they  surround  him  with  everything  sooth- 
ing, gentle,  and  acceptable.  They  provide  everything  to  cheer,  encour- 
age, and  elevate  him,  and  inspire  him  with  confidence  that  his  new 
position  in  the  hospital  is  all  for  his  good.  They  arrange  all  the  circum- 
stances, select  his  associates,  and  control  the  conversation;  they  deter- 
mine the  scenes  that  may  be  visited  and  the  ideas  that  may  be  presented, 
according  to  their  influence  on  the  over  sensitive  and  disordered  mind. 

It  is  among  the  best  established  principles  of  the  treatment  of  insanity, 
that  a  patient  should  be  opposed  or  interfered  with  as  little  as  possible, 
consistently  with  his  good;  that  his  notions  and  arguments  should  not 
be  disputed,  his  wishes  and  inclinations  indulged,  so  far  as  they  can  be 
safely,  his  opinions  and  tastes  treated  with  respect,  whdh  they  are 
proper,  but  always  with  tenderness,  and  that  everything  should  be  done 
to  encourage  his  self  respect. 

Among  the  patients  in  the  hospital  i  re  always  the  members  of  our 
own  families— our  parents,  our  brothers  and  sisters,  our  sons  and 
daughters.  From  their  childhood  they  have  been  taught  to  love  virtue 
and  abhor  vice,  to  avoid  even  the  appearance  of  wickedness,  to  associate 
with  good  and  shun  evil  company.  They  have  been  accustomed  to  run 
from  the  base,  the  degraded,  and  the  corrupt.  Their  sensibilities,  their 
tastes,  and  their  consciences  have  been  cultivated  and  shaped  in  accord- 
ance with  their  education  and  their  habits.  They  lose  none  of  these  in 
their  disease.  Insanity  tends  to  exalt  and  intensify  them.  They  become 
morbidly  sensitive,  and  even  irritable,  in  respect  to  them. 

To  put  a  convict  among  such  patients  as  these,  to  compel  them  to 
associate  with  him  in  the  same  halls,  to  eat  at  the  same  table,  to  hear 
his  coarse  and  offensive  conversation,  his  vulgar  slang,  his  profanity, 
his  curses  at  religion  and  honesty  and  religious  and  honest  men,  his 
contemptuous  jeers  at  what  they  have  been  taught  to  regard  with  rev- 
erence, his  tales  of  cunning  and  crime,  of  successful  and  unsuccessful 


163 

vilhiiny — all  this  is  in  contravention  of  the  best  principles  of  managing 
mental  disorders,  and  diminishes  if  it  does  not  counteract  the  influence 
of  the  curative  measures  that  may  be  used. 

It  is  at  least  a  singular  view  of  governmental  res])onsibility  that,  look- 
ing for  the  highest  good  of  the  community  and  the  moral  and  spiritual 
welfare  of  allots  members,  educates  children  and  youth  to  walk  in  the 
ways  of  holiness,  and  encourages  all  of  every  age  to  associate  only  with 
the  pure  and  the  upright,  when  they  are  well  and  able  to  choose  for 
themselves,  but  gives  them  felons  for  familiar  companions  when  they 
are  broken  down  Avith  mental  disease  and  too  weak  to  choose  their 
company. 

The  hospital  is  provided  for  all  the  families  of  the  commonweath.  In 
the  chances  of  life  any  one  of  us  may  be  exposed  to  the  accidents  or 
influences  that  cause  insanity,  as  well  as  to  those  that  cause  fever.  Any 
of  our  children  may  be  afllicted  with  disease  of  the  brain,  as  well  as 
with  disease  of  the  lungs. 

A  daughter,  the  idol  of  her  parents,  becomes  insane.  Her  anxious  and 
almost  agonized  friends  ta\e  her  to  the  hospital  and  leave  her  there, 
in  confidence  that  her  intensely  sharpened  sensibilities  will  be  soothed 
by  the  gentlest  associates,  the  tenderest  language  and  most  refined  man- 
ners of  those  that  surround  her;  but  she  is  shocked  to  find  in  the  same 
hall  with  her,  perhaps  sitting  next  to  her  at  table,  a  convict  from  the 
House  of  Correction,  a  woman  that  had  previously  been  the  keeper  of  a 
brothel,  and  still  retains  her  vulgar  obscenity  and  her  lascivious  ways. 
Or  a  son,  trained  in  the  same  w^ay,  may  become  deranged  on  the  subject 
of  religion.  Self  chastening  and  downcast,  he  enters  the  ward  and  finds 
among  the  inmates  a  burglar  from  the  State  Prison,  who  has  been  edu- 
cated and  practiced  in  all  manner  of  wickedness,  and  takes  a  pleasure  in 
the  display  of  his  own  corruption  and  in  offending  the  sensibilities  of 
such  as  he  considers  to  be  over  nice  and  fastidious. 

Among  the  insane  there  are  always  some  whose  recovery  is  doubtful, 
whose  chances  of  mental  life  or  death  hang  like  a  balance  so  evenly 
adjusted  that  the  slightest  weight  will  turn  the  scale,  the  least  disturb- 
ing cause  will  decide  the  issue  against  them.  These  are  watched  by  the 
officers  and  attendants  in  the  hospitals  with  the  tenderest  solicitude,  and 
guarded  with  anxious  vigilance  to  protect  them  from  every  unfavorable 
Influence.  To  such  as  these,  standing  on  the  verge  of  mental  death,  the 
presence  and  companionship  of  a  felon  from  the  prison  may  be  sufficient 
to  overthrow^  them  and  determine  the  fatal  course  of  their  disease. 

These  are  cogent  reasons,  strongly  put,  and  must  carry  conviction  to 
the  mind  of  every  man  as  to  their  propriety  and  justice.  The  convict 
insane  in  Calilbrnia  are  not  sufficiently  numerous,  however,  to  justify 
the  establishment  of  a  separate  asylum  for  their  accommodation,  but  it 
would  be  an  easy  matter  to  erect  a  suitable  building  in  conjunction  with 
the  hospital  at  San  Quentin,  to  be  devoted  to  this  class  of  patients.  The 
hospital  physician  could  give  them  the  needful  medical  attention,  and 
they  would  cost  no  more  to  take  care  of  them  there  than  at  Stockton, 
where  there  is  no  suitable  place  to  keep  or  retain  them,  to  say  nothing 
of  the  cost  of  transportation. 


164 

CHAPTER  XII. 

CHRONIC  INSANE. 

Provisions  for  Curables  and  Incurables  in  Separate  Institutions. 

SEPARATION. 

This  is  a  question  that  has  excited  some  attention  in  all  countries. 
And  though  it  has  been  practicably  decided  as  unwise  and  improper  by 
the  Association  of  Medical  Superintendents  of  American  Institutions  for 
the  Insane,  and  most  of  the  bodies  of  a  similar  character  in  other  coun- 
tries, still  it  finds  individual  advocates  in  some  of  them.  In  Italy  it  is 
by  no  means  uncommon,  while  in  Austria  and  some  of  the  German  States 
it  is  rather  the  rule  than  the  exception.  It  was  one  of  the  subjects  to 
which  we  directed  especial  attention  in  our  inquiries,  and  the  opinions  of 
every  Superintendent  with  whom  we  met  during  our  investigations  was 
solicited.  About  one  fourth  of  those  in  Italy,  one  half  in  Austria, 
Moravia,  Bohemia,  Saxony,  and  a  few  other  of  the  German  States,  per- 
haps a  tenth  in  other  continental  countries,  and  one  in  twenty  of  those 
in  Great  Britain  and  the  United  States,  were  in  favor  of  separation, 
while  all  the  rest  were  opposed  to  the  principle  and  the  practice. 
Economy  seemed  to  be  the  leading  argument  of  those  who  favored  its 
adoption,  though  a  few  placed  it  upon  higher  grounds,  and  contended 
that  while  the  chronic  and  incurable  cases  were  quite  as  well  cared  for, 
and  could  be  better  employed,  and  allowed  more  liberties  than  in  a  cura- 
tive establishment,  that  their  removal  increased  the  chances  of  recovery 
in  the  more  recent  cases;  while  another  class  seemed  to  favor  the  erec- 
tion of  different  buildings  for  the  two  classes  in  proximity  to  each  other, 
and  under  the  same  administration,  in  order  that  transfers  might  be 
made  from  the  one  to  the  other,  as  might  in  the  judgment  of  the  Super- 
intendent be  deemed  expedient. 

On  the  other  hand,  it  is  contended  that  all  such  institutions  are  more 
liable  to  degenerate  into  negligence,  inattention,  and  decay;  that  they 
are  cruel  to'the  patients  who  are  thus  told  of  their  hopeless  condition 
and  must  therefore  spend  the  rest  of  their  days  within  asylum  walls; 
that  instead  of  being  a  disadvantage  to  the  more  recent  and  curable  cases, 
the  reverse  of  this  is  actually  the  case;  that  by  their  habits  of  obedience 
and  order,  others  submitted  more  readily  and  cheerfully  to  the  rules  and 
requirements  of  the  institution ;  and  that  by  their  example  and  willing- 
ness to  labor  and  to  take  part  in  other  occupations  and  amusements,  the 
acute  cases  more  readily  joined  in  these  necessary  and  healthful  pur- 
suits; with  many  other  arguments  familiar  to  all  w^ho  have  paid  any 
attention  to  the  subject,  and  which  might  be  introduced  here  if  deemed 
of  the  least  importance.  Candor  compels  us  to  say  that  our  observations 
of  the  results  of  the  two  systems  forces  us  to  the  conclusion  that  sepa- 
: ration  is  wrong  in  principle  and  detrimental  to  the  best  interest  of  the 
insane.  While  this  is  decidedly  our  opinion,  however,  we  most  cheer- 
fully admit  that  some  of  the  asylums  for  the  chronic  insane^  were 
admirably  managed  in  every  respect,  and  their  Superintendents  intelli- 
gent, zealous,  and  attentive  men,  devoting  their  whole  time  and  all  of 
their  energies  to  the  unfortunate  patients  under  their  charge;  and  that 
this  is  true  of  some  of  these  institutions  in  all  the  countries  we  visited. 
That  at ^  Ovid,  on  Lake  Seneca,  in  the  State  of   New  York,   with  .its 


165  ^ 

splendid  location  and  beautiful  and  picturesque  surroundings,  especially 
impressed  us  most  favorably,  and  was  such  a  paradise  in  comparison  to 
the  miserable  wards  of  the  poorhouses  from  which  they  had  been  taken 
that  we  cannot  but  regard  its  establishment  as  a  boon  to  the  insane  poor 
of  the  State.  We  failed  to  discover,  however,  even  the  shadow  of  a 
reason  why  a  person  becoming  insane  in  the  neighborhood  of  this  beau- 
tiful asylum  should  be  sent  to  TJtica  because  he  w^as  considered  caral3le, 
and  that  one  in  Utica  should  be  sent  to  Ovid  because  the  reverse  of  this 
Avas  true.  It  would  seem  infinitely  better  that  each  asylum  should 
admit  all  of  either  class  occurring  in  their  respective  vicinities.  They 
should  be  as  successfully  treated  at  the  one  asylum  as  the  other;  while 
it  is  too  plain  a  proposition  to  require  argument  that  economy  of  trans- 
portation and  convenience  to  family  and  friends  would  be  best  subserved 
by  keeping  them  at  the  asylum  nearest  their  homes. 

With  regard  to  the  results  of  treatment,  the  facts  dieted  are  altogether 
in  favor  of  non-separation;  the  percentage  of  cures  being  less  and  that  of 
deaths  greatest  in  those  coulitries  where  the  system  of  separation  is  most 
generally  pursued. 


CHAPTER    XIII. 
TKEATMENT  OF  INSANITY. 


Treatment  in  English  Asylums — Mania — Epilepsy  connected  with  Insanity — Paralysis 
connected  with  Insanity — Melancholia — Observations  on  present  Treatment  of  Insanity. 

TREATMENT    IN    ENGLISH    ASYLUMS.  • 

In  the  further  report  (18-1:7)  of  the  Commissioners  in  Lunacy  for  Eng- 
land and  Wales  will  be  found  a  circular  letter,  addressed  to  the  proprie- 
tors or  Superintendents  of  Asylums,  containing  several  questions  in 
reference  to  their  methods  of  treating  cases  of  insanity,  and  the  disor- 
ders complicated  with  it. 

These  questions  referred  es2:)ecially  to  the  treatment  adopted: 

First — In  mania. 

Secondly — In  epilepsy  connected  with  insanity. 

Thirdly — Paralysis  connected  w4th  insanity. 

Fourthly — In  melancholia. 

Replies  were  received  from  fifty-three  physicians  in  charge  of  these 
establishments,  from  which  w^e  extract  the  following  as  a  fair  sj^ecimen 
of  the  w^hole,  as  elucidating  the  most  approved  methods  of  treatment 
adopted  at  that  time  by  the  most  learned  men  of  the  day. 

MANIA.      • 

First — in  regard  to  Mania: 

The  Practice  pursued  at  the  Devon  County  Asylum,  as  described  by  Doctor 

Bucknill. 

With  hot  scalp,  full  pulse,  etc.,  from  six  to  twelve  leeches  to  the  tem- 
ples or  behind  the  ears;  the  head  shaved,  and  evaporating  lotions  applied; 
a  warm  bath  for  half  an  hour  at  bedtime;  the  bowels  open,  by  one  dose 


•  166 

of  calomel  and  jalap,  followed,  if  necessary,  by  salts  and  senna;  then  one 
fourth  or  one  third  of  a  grain  of  tartar  emetic  in  solution,  every  three 
or  four  hours.  The  patient  is  not  kept  upon  low  diet;  he  is  clothed 
warmly,  and  in  the  open  air  as  much  as  possible,  and  the  opportunity  of 
muscular  exertion  and  fatigue  is  allowed.  If  he  does  not  sleej:),  two 
drachms  of  tincture  of  henbane,  with  camphor  mixed,  are  given  at  bed- 
time: if  this  does  not  succeed,  one  drachm  of  laudanum,  with  one  drachm 
of  sulphuric  aether,  are  given  when  the  acute  symptoms  have  yielded. 

When  the  head  is  cool,  the  face  pale,  the  pulse  compressible,  I  give 
warm  baths,  with  aether  and  ammonia,  and  sometimes  aether  and  lauda- 
num, or  Hoffman's  anodyne,  with  aloetic  aperients.  "When  these  symp- 
toms are  accompanied  by  great  unsomnolence  or  restlessness,  with  illu- 
sions, and  when  I  can  ascertain  that  the  patient  has  been  a  drunkard,  I 
give  wine,  aether,  and  large  quantities  of  opium,  the  indications  of  treat- 
ment being  the  same  as  in  delirium. 

When  the  patient,  with  the  ordinary'  s^-pii^toms  of  mania,  presents 
those  of  typhus  fever,  with  sordes  on  the  teeth,  picking  the  bedclothes, 
etc.,  1  give  warm  negus,  frequently  ammonia,  camphor,  aether,  with  occa- 
sional doses  of  calomel.  I  have  fortunately  never  lost  a  patient  suffering 
under  acute  mania. 

BemarJis. 

General  bloodletting  I  never  use,  and  cannot,  therefore,  give  an  opinion 
upon. 

Local  Bloodletting 

I  use  frequently,  by  leeches,  to  the  groin,  temples,  or  neck;  or  by  cupping 
the  n^pe  of  the  neck.  In  inflammatory  diseases  within  the  chest,  I  find 
that  free  cuj^ping  between  the  shoulders,  followed  by  the  use  of  anti- 
mony or  mercurials,  is  sufficient,  and  that  bleeding  is  not  required. 

Emetics 

I  have  given,  with  benefit,  where  exacerbation  of  melancholy  is  accom- 
panied by  foetid  breath,  or  discharge  of  gluey  mucous  from  the  stomach; 
also  in  incii3ient  dementia  with  lethargy  and  indigestion,  and  for  chronic 
cough. 

Purgatives. 

Patients  are  often  admitted  with  obstinate  constipation,  and  for  them 
the  stronger  purgatives  are  necessary;  but  afterwards,  this  condition  is 
not  allowed  to  prevail,  and  an  occasional,  or,  if  need  be,  a  small  daily 
dose  of  compound  rhubard  pill,  or  castor  oil,  or  decoction  of  aloes,  or 
house  medicine,  is  all  that  is  requisite.  Five  or  six  grains  of  calomel  are 
given  when  the  state  of  the  liver  requires  it,  but  I  have  now  discontinued 
the  use  of  drastic  pui'gatives.  I  have  used  them  with  decided  benefit  in 
maniacal  cases,  but  have  made  up  my  mind  that  antimonials  are  more 
manageable  and  safe.  The  house  medicine  above  mentioned  is  made  of 
the  sulphate  of  magnesia  and  soda,  with  senna,  and  extract  of  liquorice, 
decocted,  and  peppermint  water  added,  when  cool;  the  patients  like  it, 
and  a  dose,  to  produce  two  or  three  dejections,  will  often  cut  short  be- 
ginning excitement. 


167 

Antimonials. 

1  use  tartar  emetic  frequently  in  acute  and  recurrent  mania,  dissolving 
three  or  four  grains  in  mint  water,  with  simple  syrup,  and  giving  one 
twelfth  part  every  three,  or  four,  or  six  hours.  After  a  few  doses  the 
medicine  does  not  usually  produce  sickness,  the  appetite  is  not  dimin- 
ished, and  the  patient  often  gains  flesh  during  its  use.  Two  or  three 
gamboge  colored  evacuations  are  generally  passed  in  the  day.  I  believe 
that  this  medicine  acts  less  by  its  depressing  agency  than  by  some  influ- 
ence upon  the  congested  capillaries  of  the  brain,  enabling  them  to  con- 
tract. I  find  that  repeated  doses  of  ipecacuana,  though  more  nauseat- 
ing, are  not  equally  useful. 

Opiates  and  Anodynes 

I  use  sparingly.  In  the  cases  before  referred  to  as  resembling  delirium 
tremens,  opium  is  given  in  large  quantities.  It  is  not  given  if  there  is 
heat  of  the  scalp  and  a  strong  pulse.  In  other  cases  of  sleeplessness, 
where  it  is  not  thus  contra-indicated,  it  is  usually  combined  with  sul- 
phuric ether,  or  with  camphor.  Hyoscyamus,  in  combination  with  ammo- 
nia and  camphor,  is  often  given  as  a  sleeping  potion,  but  sleep  is  more 
frequently  induced  by  w^arm  baths,  cooling  lotions  to  the  head,  or  some 
food  in  the  middle  of  the  night,  than  by  means  of  narcotics.  A  plaster 
of  extract  of  belladonna  is  sometimes  used  to  the  epigastrium  or  peri- 
cardium as  an  anodyne.  Other  narcotics  have  been  tried  without  encour- 
aging results. 

Antlspas)nodlcs. 

The  compound  galbanum  pill  and  mixture,  containing  the  foetid  spirits 
of  ammonia  or  the  tincture  of  assafoetida,  are  sometimes  given  to  females 
with  uterine  derangement;  but  the  only  antispasmodic  in  frequent  use  is 
the  spirits  of  turpentine,  given  to  epileptics  with  a  view  of  reducing  the 
number  and  the  severity  of  the  fits. 

Tonics. 

Vegetable  bitters,  with  ammonia  and  aromatic  stimulants,  or  with 
mineral  acids,  or  with  liquor  potassa3,  or  with  small  doses  of  iodide  of 
potassium,  are  frequently  used;  also,  chalybeates,  in  the  form  of  steel 
wane  or  compound  steel  pills,  or  iodide  of  iron  dissolved  in  simple  syrup, 
which  prevents  its  decomposition,  are  given  in  numerous  cases  with  ben- 
efit. The  only  tonic  not  in  general  use  wdiich  has  been  given  is  the  sul- 
phate of  strychnia,  in  doses  "from  the  thirtieth  of  a  grain  upwards.  It 
is  never  given  to  produce  nervous  twitchings.  It  requires  occasional 
doses  of  aloetic  medicines,  and  is  useful  in  some  cases  of  melancholia  in 
old  people. 

Stimularits 

Are  frequently  used  medicinally.  Those  preferred  are  aether  and  ammo- 
nia, strong  beer,  porter,  and  wine.  They  are  mostly  given  to  patients 
who  are  admitted  in  a  reduced  condition,  or  to  those  w^hose  strength  is 
failing  from  general  decay,  paralysis,  or  other  cause. 


168 

Bathing. 

Tepid,  warm,  shower,  and  vapor  baths  are  used.  A  tepid  bath  is  given 
to  all  the  patients  once  a  week  in  Siimn>er  and  once  a  fortnight  in 
Winter,  for  the  sake  of  cleanliness.  Warm  baths  are  constantly  used  to 
allay  excitement  and  to  induce  sleep.  Shower  baths  are  used  as  a  tonic 
to  dyspeptic  and  hysterical  young  patients,  but  not  to  old  ones.  They 
are  also  sometimes  given  to  the  refractory  as  a  penal  remedy.  YajDor 
baths  have  been  tried  upon  some  old  persons  suffering  from  melancholy, 
with  dry  and  harsh  skin,  it  is  thought  with  benefit,  but  further  experi- 
ence is  required. 

Practice  pursued  at  Middlesex  {or  Hamvell)  County  Asylum,  as  described  by 

Doctor  Conolly. 

A  kind  and  soothing  reception,  immediate  removal  of  restraints,  a  warm 
bath,  clean  clothing,  comfortable  food,  encouraging  words,  a  medical 
treatment  first  directed  to  any  manifest  bodily  disease  which  may 
occasion  the  cerebral  disturbance,  as  of  the  uterus,  stomach,  etc.,  or  the 
general  loss  of  strength;  and  if  such  disease  or  debility  is  not  manifest, 
attempts  to  allay  the  irritation  of  the  brain  more  directly  by  leeches 
occasionally  applied  to  the  head,  gentle  aperients,  moderate  doses  of 
tartarized  antimony,  sometimes  combined  with  sedatives,  cold  applica- 
tions to  the  head,  blisters  behind,  the  neck,  shaving  the  head,  and  friction 
of  the  scalp  with  the  tartarized  antimony,  the  warm  bath,  or  in  violent 
cases  the  cold  shower  bath  efficiently  applied;  tranquility,  occasional 
exercise  in  the  open  air,  exercise  and  occupation  in  chronic  cases,  clean- 
liness, order,  good  diet,  attention  to  relieve  heat  and  thirst,  particularly 
in  the  night,  a  careful  avoidance  of  everything  that  can  irritate  the 
brain,  including  the  avoidance  of  the  strait  waistcoat,  etc.  Antimony 
and  all  sedatives  are  of  uncertain  effect,  and  sometimes  of  none,  time 
seeming  alone  to  effect  a  cure,  j)rovided  -proper  and  constant  care  be 
taken  of  the  patient. 

General  Remarks. 

It  will  be  observed  that  I  consider  the  direct  treatment  of  any  form  of 
insanity  by  mere  medicinal  application  to  be  very  limited;  but  the  indi- 
rect treatment  of  mental  maladies  by  innumerable  means  acting  upon 
the  body  and  mind  of  immeasurable  importance.  These  means  can,  I 
believe,  seldom  be  efficiently  applied,  except  in  well  constructed  and 
well  conducted  asylums,  superintended  by  well  educated  men,  aided  by 
benevolent  and  active  attendants.  By  such  means  I  believe  many  insane 
persons  to  be  capable  of  cure,  and  all,  however  incurable  and  hojDeless, 
capable  of  improvement  and  relief 

I  will  merely  add,  that  I  am  convinced  that  general  bloodletting  is 
rarely  admissible,  and  generally  dangerous  in  insanity,  and  that  local 
bleeding  by  leeches  is  safe  and  serviceable  in  most  cases.  I  have  no 
faith  in  emetics.  1  think  purgatives  are  often  needlessly  employed. 
Antimony  is  often  of  temporary  service;  sedatives,  though  occasionally 
most  efficacious,  are  also  most  uncertain  in  their  effects.  The  acetate  of 
morphia,  the  hyoscyamus,  and  the  cannabis  indica,  have  apj^eared  to  me 
to  be  the  most  frequently  useful.  Tonics  and  stimulants  are  frequently 
of  service,  and  every  form  of  bathing  in  different  instances.  I  have 
ceased  to  employ  the  douche  bath,  as  it  occasions  more  distress  to  the 


169 

patient  than  the  shower  bath  or  than  cold  affusion,  without  correspond- 
ing benefit. 

A  liberal  diet,  moderate  use  of  malt  liquor,  exercise  out  of  doors, 
employment,  recreation,  mental  occupation,  friendly  intercourse,  and 
judicious  religious  attentions,  are  all  important  anxiliaries  to  amend- 
ment. 

Practice  in  the  Surrey  County  Asylum,  as  described  by  Sir  Alexander  Morison. 

If  the  patient  is  brought  under  mechanical  restraint,  this  is  removed 
and  the  warm  bath  is  generally  employed.  The  hair,  if  considerable,  is 
thinned,  and  in  some  cases  removed;  and  recourse  is  had  to  laxative 
medicines,  as  jalap,  rhubarb,  senna,  calomel,  sulphate  of  magnesia,  cro- 
ton  oil,  castor  oil.  ]N"auseating  medicines  are  sometimes  given  to  allay 
excitement — in  particular,  small  doses  of  tartrate  of  antimony;  also  . 
sedatives,  as  hyoscyamus,  morphia,  camphor,  nitre.  Cooling  lotions  are 
applied  to  the  head.  Topical  bloodletting  by  cupping  or  by  leeches 
(general  bloodletting  has  not  been  employed).  Blisters  to  the  nape  of 
the  neck.  Animal  food  daily.  Porter  or  wine  have  in  some  cases  been 
given.  Few  recent  cases  of  mania  have  been  received,  owing  to  the 
vicinity  of  the  public  hospitals  of  Bethlem  and  St  Luke's. 

Practice   pursued    at   Stafford    County   Lunatic  Asylum,    as    described    by 

Mr.  James   Wilkes. 

In  the  medical  treatment  of  the  cases  of  mania  sent  to  this  Asylum 
the  first  indication  is  sought  in  the  careful  examination  of  the  patients' 
general  condition,  in  ascertaining  how  far  the  cerebral  excitement 
depends  upon  increased  vascular  action,  and  in  detecting  the  nature 
of  any  bodily  disorder  that  may  be  present.  Although  the  latter  is 
often  obscure,  still  some  derangement  of  the  thoracic  or  abdominal 
organs,  either  functional  or  organic,  is  a  constant  complication  of  mania, 
and  remedies  directed  to  their  relief  are  often  sufiicient  to  cure  the  men- 
tal disorder. 

In  many  instances  the  patient  when  brought  to  the  asylum  is  in  so 
prostrate  a  condition,  either  from  exhaustion,  produced  by  the  disorder 
itself,  from  having  refused  food,  or  from  the  extent  to  which  bleeding, 
purgatives,  and  low  diet  have  been  carried,  that  the  course  of  treatment 
IS  at  once  clear,  and  good  nourishing  diet,  stimulants,  and  tonics  often 
restore  the  patient,  unless,  as  is  too  frequently  the  case,  the  symptoms 
of  sinking  have  already  set  in. 

The  injurious  efi'ect  of  active  medical  treatment  in  cases  of  mania,  and 
the  tendency  there  is  to  exhaustion  and  sinking  is  so  fully  established 
that  the  general  practice  in  this  asylum  is  chiefly  directed  to  supporting 
the  vital  powers,  subduing  the  cerebral  irritation,  and  correcting  the 
existing  physical  derangement,  not  by  any  peculiar  or  specific  mode  of 
treatment,  but  uj^on  ordinary  principles. 

In  pure  cases  of  mania,  however  great  the  excitement  may  be,  general 
bleeding  is  never  employed.  The  cerebral  irritation  is  often  materially 
relieved  and  every  advantage  gained  by  local  bleeding,  without  mate- 
rially depressing  the  patient's  strength.  For  this  purpose,  leeches  to  the 
temples  or  behind  the  ears,  and  cupping  on  the  same  parts  or  on  the 
nape  of  the  neck,  are  the  means  usually  employed,  due  regard  being  had 

22 


170 

in  using  these  to  the  amount  of  vascular  action  and  condition  of  the 
patient. 

Any  obvious  derangement  in  the  patient's  general  health,  or  in  the 
function  of  any  particular  organ,  is  attended  to,  and  appropriate  reme- 
dies prescribed;  but  the  usually  defective  state  of  the  digestive  and 
assimilative  organs  renders  attention  to  them  of  much  importance.  The 
bowels,  when  torpid,  are  freely  acted  upon,  and  if  there  is  nothing  to 
contra-indicate  such  a  course,  the  morbid  and  accumulated  secretions  are 
removed  by  a  dose  or  two  of  calomel,  either  alone  or  combined  with  colo- 
cynth;  and  if  the  patient  refuses  medicine,  croton  oil  and  enemata  are 
employed.     If  there  is  much  exhaustion,  an  enema  alone  is  prescribed. 

The  various  narcotics  and  sedatives  are  constantly  used  in  this  asylum 
in  the  treatment  of  cases  of  mania,  both  acute  and  chronic,  and  though 
they  are  uncertain,  and  no  very  precise  rule  can  be  laid  down  for  their 
employment,  they  are,  on  the  whole,  found  to  be  highly  serviceable. 
They  appear  to  be  of  the  most  benefit  in  cases  attended  with  great  ner- 
vous excitement,  and  are  of  little  use  and  often  positively  injurious  when 
there  is  much  febrile  disturbance,  especially  in  typhoid  symptoms  or  vas- 
cular determination  to  the  head.  The  description  of  narcotics  to  be  used, 
and  also  the  dose,  can  only  be  determined  by  experience  in  individual 
cases.  The  free  action  of  the  bowels  should  be  previously  obtained,  and 
then  either  solid  opium,  the  tincture,  Battley's  sedative  solution,  or  mor- 
phia, are  prescribed,  combined  in  some  cases  with  antimony  or  ipecacu- 
ana,  hyoscyamus,  camphor,  or  a?ther.  In  cases  of  great  excitement 
any  of  these,  in  small  doses,  rather  increase  it,  and  it  is  important  to 
prescribe  it  in  full  doses  and  frequently  to  keep  up  the  narcotic  action 
by  repeating  it  every  four  or  six  hours.  The  Indian  hemp  has  latterly 
been  used  here,  and,  when  genuine,  is  a  valuable  and  powerful  remedy. 
In  several  cases  in  which  I  have  employed  it  the  excitement  has  been 
subdued  and  sleep  obtained,  when  large  and  repeated  doses  of  opium  and 
morphia  only  added  to  the  restlessness  of  the  patient.  Its  after  effects 
also  seem  to  be  less  injurious  than  those  of  opium;  constipation  is  not 
produced,  and  the  constitutional  disturbance  is  often  relieved. 

When  there  is  much  febrile  disturbance,  with  heat  of  skin  and  thirst, 
the  saline  mixture  (composed  of  liq.  ammonise,  acet.  vin.  antimon.,  pot. 
tart.,  tinct.  hyoscyami,  potassse  nitras,  and  mixtura  camphoras)  is  fre- 
quently prescribed  with  good  effect,  the  action  of  the  skin  being  pro- 
moted by  it  and  the  restlessness  relieved. 

In  certain  cases  of  acute  mania,  and  also  iu  the  chronic  form,  the 
employment  of  tonics  is  found  to  be  of  much  use,  especially  in  enfeebled 
constitutions  with  weak  pulse  and  depressed  vital  powers.  Quinine, 
iron,  and  the  vegetable  bitters,  combined  with  stimulants  and  aromatics, 
are  prescribed  in  these  cases. 

The  exitement  in  mania  is  rather  increased  than  relieved  by  low  diet, 
and  the  usual  difficulty  is  to  get  the  patients  to  take  sufficient  food.  The 
diet  used  here  is  ample  and  nutritious,  and  the  principle  of  supporting 
the  patient's  strength  and  making  up  for  the  waste  and  exhaustion  which 
are  going  on  in  the  system,  by  an  abundant  supply  of  nutriment,  is  here 
fully  acted  upon. 

Thus,  jDatients  who  are  laboring  under  much  excitement  are  not 
restricted  to  the  ordinary  dietary,  but  are  supplied  with  meat  daily, 
soup,  milk,  eggs,  sago,  arrow  root,  etc.,  and  often  with  wine,  brandy, 
ale,  and  other  stimulants;  and  daily  experience  proves  that  in  many 
chronic  cases  life  may  be  prolonged  by  a  liberal  diet,  and  that  in  recent 


171 

cases  it  alone  often  cures  the  patient  and  crcn  supersedes  medical  treat- 
ment. 

The  use  of  the  warm  and  shower  bath  is  found  here  to  be  of  much 
importance  in  the  treatment  of  mania.  The  warm  bath  seems  to  exert 
a  sedative  influence  in  many  cases  of  excitement,  and  may  generally  be 
employed  in  safety.  The  tepid  or  cold  shower  bath,  when  cautiously 
employed,  is  also  a  powerful  means  of  subduing  the  paroxysm,  and  many 
patients  acknowledge  that  it  alone  has  cured  them.  It  seems  to  be  of 
the  greatest  benefit  in  cases  of  mania  attended  with  heat  of  scalp  and 
increased  vascular  action,  and  when  unattended  with  much  general  dis- 
turbance of  the  system  or  symptoms  of  thoracic  or  abdominal  disorder. 
In  the  latter  complications  the  use  of  the  shower  bath  is  at  once  contra 
indicated,  and  the  warm  bath  may  be  substituted  for  it. 

Cold  lotions,  ice,  and  cold  affusion  to  the  head  are  constantly  employed 
whenever  heat  of  scalp,  suffused  eyes,  and  increased  arterial  action  indi- 
cate fullness  of  the  cerebral  vessels. 

In  acute  cases  of  mania,  blisters  are  not  often  used  here,  as  they  serve 
to  add  to  the  excitement  by  the  irritation  they  produce.  In  cases  of 
chronic  mania  they  are  employed,  and  especially  when  there  is  evidence 
of  slow  mischief  going  on  in  the  brain. 

Remarks. 

Emetics. — These,  as  directed  to  the  treatment  of  insanity,  are  never 
employed  in  this  asylum,  nor  are  the  depressing  doses  of  tartarized  anti- 
mony which  some  practioners  recommend.  In  cases  of  gastric  or  biliary 
derangement,  in  which  emetics  would  be  indicated  under  other  circum- 
stances, they  are  occasionally  employed. 

To  the  observations  on  general  bleeding  I  may  add  that  not  only  is 
there  a  want  of  proof  of  relief  having  been  obtained  by  this  popular 
remedy  in  any  of  the  cases  brought  to  this  asylum  in  which  it  has  been 
practiced,  but  its  injurious  effects  have  been  so  repeatedly  and  decidedly 
witnessed,  either  in  producing  fatal  exhaustion  or  reducing  the  patients 
to  a  hopeless  state  of  imbecility,  that  in  cases  of  simple  mania,  uncom- 
bined  with  inflammation,  its  adoption  cannot  be  too  strongly  deprecated. 

In  reference  to  the  diet  of  the  insane,  daily  observation  increases  my 
conviction  that  a  liberal  supply  of  good,  nutritious  food  both  adds  to  the 
recoveries  and  diminishes  the  mortality  in  institutions  for  the  insane, 
being  an  important  means  of  cure  in  recent  cases  and  of  prolonging  life 
in  the  chronic  and  incurable. 

Practice  pursued  at  Brislington  House,  as  described  by  Doctors  F.  and  C.  Fox. 

In  cases  of  mania,  which,  we  must  observe,  seldom  come  under  our 
notice  in  the  incipient  stage,  we  have  rarely  seen  benefit  derived  from 
general  bleeding.  Small  quantities  of  blood  are  often  abstracted  by  the 
cupping  glasses  from  the  nape  of  the  neck;  the  bowels  are  evacuated 
freely  by  aloetics  combined  with  nauseating  doses  of  tartar  emetic  taken 
each  night,  and  succeeded  b}^  castor  oil  in  the  morning.  The  cold  plunge 
or  shower  bath  is  usually  taken  each  morning,  and  it  is  repeated  with 
much  advantage  in  the  evening  in  cases  of  sleeplessness.  In  the  more 
protracted  cases  of  mania,  the  principal  medical  treatment  has  consisted 
of  counterirritants  to  the  scalp  or  to  the  pit  of  the  stomach,  with  atten- 
tioti  to  the  state  of  the  skin  and  bowels,  the  maintenance  of  a  warm  at- 


172 

mosphere  in  the  sleeping  ajDartments,  a  plain  and  nutritious  diet,  and  the 
use  of  much  exercise,  unattended  with  violent  bodily  exercise. 

Remarks. 

We  have  found  it  impossible  to  comj^rise  under  either  of  the  foregoing 
heads  a  large  proportion  of  the  cases  which  have  been  in  this  asylum,  or 
to  describe  any  uniform  mode  of  treatment  as  applicable  to  the  cases  in 
either  of  the  divisions.  In  those  cases  of  moral  perversion  which  occur 
without  the  existence  of  any  delusion,  we  have  seen  much  benefit  de- 
rived from  the  system  adoj^ted  in  an  asylum.  In  this  form  of  insanity 
we  have  generally  discovered  a  propensity  to  excess  in  diet  and  to 
intoxication,  or  to  the  indulgence  of  lascivious  habits;  and  we  have 
found  a  spare  diet,  cold  bathing,  saline  23urgatives,  early  rising,  and 
active  exercise,  with  a  2)rolonged  sejDaration  from  the  scenes  and  habits 
of  former  excitement,  most  useful  to  such  patients.  "We  believe  that 
such  a  system  can  be  enforced  only  in  an  as^'lum,  and  that  moral  treat- 
ment and  the  services  of  a  chaplain  are  of  much  importance  in  these 
cases. 

General  bloodletting  is  only  resorted  to  by  us  in  those  cases  of  mania 
in  which  the  physical  condition  of  the  patient  induces  the  apj)rehension 
of  apoplexy,  and  never  for  the  j^urpose  of  quieting  a  paroxysm  of 
excitement.  Previously  to  admission,  most  of  our  patients  have  been 
under  medical  treatment,  and  we  have  often  had  reason  to  suspect  that 
the  general  bloodletting  to  which  they  have  been  subjected  has  been 
detrimental,  and  that  it  has  in  some  cases  induced  jDcrmanent  fatuity. 
We  have  found  general  bleeding  useful  in  some  cases  of  melancholia. 
In  most  forms  of  insanity,  Ave  find  benefit  derived  by  the  local  abstrac- 
tion of  blood  from  the  head  or  nape  of  the  neck;  in  some  cases,  by  the 
apj^lication  of  leeches  to  the  pit  of  the  stomach,  and  in  females,  to  the 
groin. 

We  value  antimonials  in  the  treatment  of  insanity  much  less  for  their 
emetic  action  than  the  change  which  they  effect  in  the  circulation,  and 
we  find  that  this  object  is  gained  by  nauseating  doses,  which  tend  to 
allay  maniacal  excitement  and  to  procure  sleep. 

AYe  consider  that  the  use  of  purgatives  is  indicated  in  almost  all 
forms  of  insanity  in  the  incipient  stages,  and  we  find  them  esj^ecially 
useful  in  melancholia,  until  they  can  be  dispensed  with  by  attention  to 
diet  and  exercise.  Opiates  and  anodynes  have  frequently  been  resorted 
to  by  us,  with  a  hope  of  success  which  has  but  rarely  attended  their 
use.  In  paralysis  and  epilepsy  we  have  derived  benefit  from  the  use  of 
antispasmodics,  tonics,  and  stimulants,  and  in  some  cases  of  melancholia 
dependent  upon  uterine  disturbance,  but  we  have  not  found  these  reme- 
dies in  the  treatment  of  mania. 

We  attach  much  value  to  the  use  of  hot  and  cold  bathing.  In  mania, 
we  chiefly  use  the  cold  plunging  and  cold  shower  bath,  and  we  find  the 
warm  bath  and  the  cold  shower  bath,  with  the  feet  of  the  patient 
immersed  in  hot  water,  more  applicable  in  cases  of  melancholia. 

We  are  of  opinion  that  maniacal  and  melancholic  patients  almost 
invariably  require  a  generous  and  nutritious  diet;  this  we  find  to  be 
equally  necessary  in  cases  of  chronic  insanity.  In  epilepsy  and  paral- 
ysis, connected  with  insanity,  we  often  find  it  necessary  to  place  the 
patients  upon  a  very  restricted  system  of  diet. 


173 

EPILEPSY   IN    CONNECTION    WITH   INSANITY. 

Secondly — in  regard  to  epilepsy,  Ave  quote: 

Remedies  used  in  Cases  of  Epilepsy  at  Devon  County  Asylum.,  as  described 

by  Di\  Bucknill. 

The  patients  are  placed  on  a  wholesome  and  nutritious  diet  and 
regimen.  Indigestion  is  treated  by  tonics  and  other  appropriate  reme- 
dies; costiveness  is  removed  by  small  daily  doses  of  co.  rhubarb  pills, 
decoct,  of  aloes,  castor  oil,  or  house  medicine;  when  the  fits  are  severe, 
one  drachm  of  sj^t.  of  turpentine,  with  mx.  of  liq.  of  potass,  every  four 
hours;  sinapism  to  the  legs  and  feet,  and  three  or  four  ounces  of  blood 
from  the  neck  by  cupping. 

Turpentine  undoubtedly  diminishes  the  strength  and  frequency  of  the 
fits,  and  I  have  only  seen  it  once  produce  bloody  urine.  In  young 
patients,  the  frequent  application  of  croton  oil  to  the  scalp,  and  the  long 
continued  use  of  mercurial  alteratives  (hyd.  chloria.  is  preferred)  have 
apparently  effected  cures. 

Bemedies  used  in  Cases  of  Epilepsy  at  the^  Middlesex  {or  Hanwell)  Asylum, 

by  Doctor  Conolly. 

Cases  of  epilepsy  being  generally  associated  with  occasional  mania, 
are  treated  on  the  principles  before  mentioned.  In  the  fit,  care  is  taken 
that  the  patient  sustains  no  injury.  Epileptics  should  sleep  on  low  beds 
or  cribs,  or  beds  on  the  floor.  In  the  excited  or  maniacal  state  nothing 
is  done  to  irritate  the  patient.  When  restraints  were  resorted  to  the 
epileptics  were  often  furious,  and  generally  dangerous;  since  their  dis- 
use, the  epileptic  ward  has  become  the  quietest  in  the  asylum.  I  have 
never  seen  a  case  of  epilepsy  in  an  adult  permanently  cured  by  any 
medicine  whatever.  Attention  to  the  general  health,  the  occasional 
application  of  leeches  to  the  head,  blisters  behind  the  neck,  and,  in  some 
cases,  an  incision  in  the  scalp,  have  served  to  lessen  the  cerebral  conges- 
tion. Setons  appear  to  me  to  be  useless,  as  well  as  issues,  and  all  other 
modes  of  severe  counter-irritation. 

Bemedies  used  in  Cases  of  Epilepsy  at  the  Surrey  County  Lunatic  Asylum,  by 

Sir  A.  Morison,  M.  D. 

Many  cases  of  this  description  have  been  admitted.  In  them  attention 
is  given  to  the  general  health  by  remedies  tending  to  improve  the  state 
of  the  digestive  organs. 

Leeches,  in  some  cases,  have  been  of  service;  also,  rubefacients,  coun- 
ter-irritants, and  blisters,  and  tartrate  of  antimony,  externally  applied. 

Preparations  of  silver  and  turpentine  have  been  given  internally,  but 
with  little  good  effect. 

Organic  mischief,  to  a  greater  or  less  extent,  has  been  found  in  the 
brain  in  all  the  cases  of  epilepsy,  connected  with  insanity,  which  have 
been  examined  in  this  asylum. 

Bemedies  used  in  Cases  of  Epilepsy  at  the  Stafford  County  Asylum,  by  Mr. 

Wilkes. 

The  cases  of  epilepsy  usually  sent  to  this  asylum  are  usually  connected 
with  congenital  defect,  or  are  of  such  long  standing  and  so  intense  in 


174 

degree  that  any  hope  of  cure  or  material  relief  is  out  of  the  question; 
and  the  only  indication  seems  to  be,  to  attend  to  the  patient's  general 
health,  and  guard  against  and  relieve  cerebral  congestion.  In  cases  of 
obvious  debility  the  employment  of  tonics  is  of  use,  especially  those  of 
the  mineral  class,  as  the  preparations  of  iron,  zinc  and  the  nitrate  of 
silver.  The  excessive  state  of  congestion  ^^hich  frequently  occurs  is 
here  treated  by  the  free  exhibition  of  purgatives,  as  large  doses  of  calo- 
mel and  croton  oil;  the  application  of  leeches  or  cupping  to  the  temples; 
ice,  cold  lotions,  and  cold  affusions  to  the  head,  blisters  to  the  nape  of 
the  neck,  stimulating  pediluvia  and  enemata,  especially  those  containing 
turpentine  and  assafoetida.  While  the  diet  should  be  nourishing,  it 
should  not  be  stimulating;  and  the  disposition  to  over-nutrition  should 
be  carefully  guarded  against.  As  a  general  rule,  the  free  action  of  the 
bowels  is  kept  up  by  the  frequent  exhibition  of  purgatives. 

Remedies  used  in  Cases  of  Epilepsy,  at  Brisliagton  House,  by  Doctors  F.  and 

a  Fox. 

If  such  cases  are  of  recent  date,  we  have  sometimes  seen  good  results 
from  the  use  of  nitrate  of  silver,  with  small  doses  of  turpentine;  an 
incision  on  the  scalp,  leeches  on  the  perinseum,  the  tepid  shower  bath, 
much  friction  of  the  skin,  as  much  pedestrian  exercise  as  the  patient  can 
accomplish,  and  a  restricted  vegetable  diet,  have  often  been  useful.  By 
paying  close  attention  to  the  periodical  tendency  which  this  disease  so 
frequently  displays,  and  by  meeting  the  gradual  increase  of  nervous 
irritability  by  a  small  local  bleeding  and  a  moderate  anodyne,  we  have 
sometimes  succeeded  in  prolonging  the  intervals  between  the  attacks, 
and  on  some  occasions  in  effecting  a  cure. 

PARALYSIS    CONNECTED    WITH    INSANITY. 

Thirdly — In  regard  to  paralysis,  we  quote: 

Remedies  used  in  Cases  of  Paralysis  at  Devon  County  Asylum,  by  Doctor 

Bucknill. 

When  the  patients  are  not  admitted  in  a  bedridden  and  ulcerated  con- 
dition, good  diet  and  regimen  generally  improve  the  strength,  and  the 
progress  of  the  disease  ai^pears  to  be  very  slow.  A  few  leeches  are 
sometimes  applied  to  the  temples,  when  the  face  is  apt  to  flush  and  the 
scalp  to  become  heated.  Having  observed  that  some  patients  who  had 
sore  legs  appeared  to  be  more  comfortable  when  the  suppuration  was 
free,  I  have  tried  setons,  but  cannot  as  yet  give  an  opinion  about  their 
utility.  In  sinking  cases,  wine  and  porter  are  freely  given,  and  slough- 
ing sores  are  dressed  with  equal  parts  of  tinct.  of  kino  and  liq.  of  subace- 
tate  of  lead,  and  a  yeast  cataplasm  is  ax)plied  for  three  or  four  hours 
ever}^  second  day. 

Remedies  used  in  C-ases  of  Paralysis  at  the  Middlesex  (or  Hanwell)  County 
Asylum,  by  Doctor  Conolly. 

The  paralytic  complication  {parcdysie  generate  of  the  French)  makes 
great  care  necessary  to  prevent  injury  to  the  patient.  Good  food,  porter, 
occasional  tonics,  and  in  all  cases  warmth  and  comfort,  evidently  prolong 
life  for  many  years.     The  patients  neither  bear  reduC'tiori  nor  excite- 


175 

ment;  even  baths  are  scarcely  to  be  recommended.  Leeches  and  aperi- 
ents are  somethnes  required  to  lessen  congestion  in  the  head.  Small 
doses  of  calomel  and  squills  have  occasionally  seemed  useful,  but  I  am 
satisfied  that  all  specific  modes  of  treating  this  form  of  paralysis  are 
inefl'ectual  as  regards  a  cure.  Many  of  the  miseries  of  the  malady,  as 
uncleanliness,  ulceration,  and  fits  of  violent  anger,  are  prevented  or  long 
retarded  b}'  kind  treatment  and  the  absence  of  all  bodily  restraint. 

Remedies  used  in   Cases  of  Paralysis  at  the  Surrey   County  Asylum,  by  Sir 
Alexander  Morison,  M.  JD. 

The  same  may  be  said  as  to  the  existence  of  organic  mischief  in  cases 
of  this  description,  of  which  a  large  number  have  been  examined.  The 
remedies  employed  have  been  laxatives,  leeches,  blisters,  generous  diet, 
and  tonics,  especially  quinine.  In  most  cases  recourse  has  been  had 
to  water  beds  on  account  of  the  extensive  ulceration  which  frequently 
attends  the  termination  of  these  unfortunate  cases. 

Remedies  used  in  Cases  of  Paralysis  at  the  Stafford  County  Asylum,  by  31  r 

Wilkes. 

Cases  of  paralysis  connected  with  insanity,  like  those  of  epilepsy,  are 
rarely  sent  to  this  asylum  before  the  disease  is  in  an  advanced  stage,  and 
as  far  as  my  experience  goes,  the  patient  in  a  hopeless  and  incurable  state. 
Life,  in  many  cases,  is  prolonged  by  care  and  attention,  and  it  is  especially 
needful  to  guard  against  congestion  of  the  brain,  and  so  to  regulate  the 
diet  as  not  to  encourage  undue  nutrition  and  plethora,  which  is  often  at- 
tended with  serious  aggravation  of  the  symptoms.  The  occasional  exhi- 
bition of  purgatives,  and  even  those  of  an  active  character,  are  necessary 
to  relieve  congestion,  and  the  tendency,  which  usually  exists,  to  consti- 
pation. Local  bleeding,  by  means  of  leeches  and  cupping,  to  the  temples, 
behind  the  ears,  or  nape  of  the  neck,  is  also  employed,  together  with 
blisters  and  other  counter-irritation,  especially  when  there  are  symptoms 
of  coma.  The  iodide  of  iron  and  a  mild  mercurial  course,  combined  in 
some  cases  with  tonics,  have  been  tried  in  this  asylum,  but  without  per- 
manent benefit;  the  organic  changes  in  the  brain,  upon  which  the  disease 
depends,  appearing  to  be  be^^ond  the  influence  of  medical  treatment. 

Remedies  used  in  Cases  of  Paralysis  at  Brislington  House,  by  Doctors  F.  and 

C  Fox. 

We  have  arrested  this  disease  by  the  use  of  iodide  of  mercury,  by  the 
prolonged  application  of  open  blisters  to  the  parietal  junction  of  the  scalp, 
and  by  the  use  of  the  electro-galvanic  apparatus  to  the  affected  portions 
of  the  body. 

As  such  cases  have  generally  occurred  in  aged  or  wasted  constitu- 
tions we  have  often  had  recourse  to  chalybeate  medicines,  but  have 
experienced  their  injurious  efi'ects  upon  the  mental  disease.  These  cases 
are  rarely  presented  to  our  notice  in  a  curable  state. 


17/3 

MELANCHOLIA. 

Fourthly — in  regard  to  melancholia,  we  quote: 

Remedies  used  in   Cases  of  Melancholia  in  the  Devon  County  Asylum^  by 

Doctor  Bucknill. 

I  endeavor  to  appreciate  and  to  treat  the  bodily  condition  wherever  it 
is  disordered.  In  young  women  with  suppression  of  the  menses,  I  order 
leeches  to  the  vulva,  hip  baths,  aloetic  aperients,  and  often  chalybeates. 
In  elder  women,  at  the  critical  period,  an  occasional  blue  pill,  a  small 
daily  dose  of  decoction  of  aloes,  vegetable  tonics,  sometimes  galbanum, 
or  assafoetida,  or  chalybeates.  In  various  cases  with  dyspepsia,  I  have 
given  bitter  infusions  with  mineral  acids  or  alkali,  or  gr.  iij.  doses  of 
iodide  of  potassium  with  liq.  potassas  or  lime  water. 

In  some  cases  emetics  have  been  very  beneficial,  and  shower  baths  are 
good  tonics  and  safe  in  the  Summer  months.  When  pain,  sense  of  burn- 
ing, etc.  is  felt  in  the  head,  I  have  given  blue  pill  to  twitch  the  gums, 
and  used  counter-irritation  to  the  scalp.  When  the  skin  is  dry,  warm 
bath  with  friction,  or  vapor  baths  are  used.  I  have  found  the  electro- 
galvanic  apparatus  beneficial  in  some  cases,  when  used  moderately  so  as 
not  to  produce  fear  or  pain. 

Hemedies  used  in  Cases  of  Melancholia  at  Middlesex  (^or  HamcelV)  Asylum^ 

by  Dr.  Conolly. 

The  attention  is  first  directed  to  any  manifest  bodily  disorder,  or  to 
existing  debility  or  plethora,  often  with  the  eftect  of  curing  the  patient. 
Leeches  behind  the  ears  or  to  the  forehead,  blisters  behind  the  neck, 
small  and  sometimes  large  doses  of  sedatives,  give  relief  in  some  cases. 
The  warm  bath  is  soothing;  and,  in  some  instances,  the  shower  bath  has 
great  efi'ect.  Occupation  of  mind  and  body,  cheerful  and  encouraging 
conversation,  and  the  absence  of  all  restraints  or  apparatus  calculated  to 
alarm  the  patient,  are  of  great  importance;  direct  attempts  to  stimulate 
the  faculties,  by  various  impressions,  by  frequent  change  of  scene,  or  by 
wine  or  spirituous  liquors,  are  seldom  successful,  and  sometimes  very 
hurtful.  Tonics  are,  in  some  cases,  serviceable,  as  calumba,  cascarilla, 
or  preparations  of  iron.  AVhen  plethora  is  manifestly  present,  daily 
saline  aperients  are  generally  useful. 

Remedies  used  in  Cases  of  Melancholia  in  the  ^^iurrey  County  Asylum,  by  Sir 
Alexander  Morison,  M.  D. 

Few  recent  cases  of  this  description  have  been  sent  to  this  asylum, 
owing  to  the  cause  stated  in  regard  to  recent  cases  of  mania. 

Laxatives,  sedatives,  tonics,  warm  baths,  shower  baths,  and  blisters, 
have  been  chiefly  employed. 

The  most  numerous  cases  are  those  of  dementia,  in  a  more  or  less 
advanced  stage.  The  object  in  them  has  been  to  imj^rove  the  general 
health.  Warm  baths,  shower  baths,  and  blisters,  have  been  occasionally 
employed. 

In  all  cases  where  practicable,  recourse  is  had  to  occupation,  useful  or 
agreeable.     As  little  restraint  is  employed  as  is  deemed  to  be  consistent 


177 

with  the  safety  of  the  patient  and  of  others,  and  this  is  continued  for  as 
short  a  time  as  possible. 

Eemedles  used  in  Cases  of  Melancholia  at  Stafford  County  Asylum,  by  Mr. 

James  WiUies. 

This  state  is  generally  found  to  be  connected  with  a  low  condition  of 
health  and  a  depressed  state  of  the  vital  powers,  independent  of  direct 
symptoms  of  cerebral  disorder,  and  the  medical  treatment  followed  in 
this  asjdum  is  chiefly  directed  to  restore  the  functions  of  any  organ 
which  may  seem  to  be  impaired,  and  to  invigorate  the  patient's  general 
health.  The  frequent  association  of  melancholia  with  various  forms  of 
dyspepsia  and  disorders  of  the  assimilative  organs  is  not  overlooked; 
neither  are  the  defective  quality  and  quantity  of  the  urine,  and  the 
changes  which  so  often  take  place  in  its  chemical  composition. 

The  employment  of  purgatives  is  rarely  to  be  dispensed  with,  and 
these  are  often  required  in  large  and  repeated  doses  to  obviate  the  ten- 
dency to  constij^ation  which  usually  exists.  The  various  combinations 
of  tonics  and  stimulants  with  purgatives  are  here  advantageously  used, 
as  the  bitter  infusions  with  sulphate  of  magnesia,  and  compound  spirits 
of  ammonia,  aloes,  quinine,  and  iron,  in  the  form  of  pills,  with  sulphate 
of  iron;  alterative  doses  of  calomel,  or  blue  pill,  are  also  given  when 
the  functions  of  the  liver  are  disordered.  When  there  is  headache  and 
symptoms  of  fullness  in  the  head,  the  application  of  leeches  is  of  service; 
and  much  benefit  is  often  derived  in  cases  of  melancholia  from  the  regu- 
lar use  of  the  shower  bath  whenever  there  is  no  obvious  reason  for  not 
applying  it. 

Sedatives  and  narcotics  in  various  forms  are  used  in  this  asylum  with 
gi-eat  benefit,  the  restlessness  of  patients  being  subdued  by  them  and  the 
nervous  system  tranquilized.  The  preparation  of  opium  (especially 
Battley's  sedative  solution),  morphia,  Indian  hemp,  hyoscyamus,  conium, 
camphor,  lactucarium,  in  different  combinations,  are  given  with  the  best 
effect.  The  diet  in  cases  of  melancholia  requires  regulating  in  reference 
to  the  state  of  the  digestive  organs,  but  should  always  be  nutritious, 
and  in  many  cases  may  be  advantageously  combined  with  stimulants. 

Remedies  used   in   cases   of  Melancholia  at  Brislington  House,  by  Doctors 

F.  and  C.  Fox. 

In  melancholia  which  has  succeeded  to  an  attack  of  mania  we  have 
.80  often  found  that  the  disorder  has  again  reverted  to  the  maniacal  form,, 
that  we  generally  confine  the  medical  treatment  to  moderate  evacuations, 
of  the  patient's  bowels,  with  regulation  of  the  diet,  and  we  encourage, 
that  increased  indication  to  quiet  and  to  sleep  which  such  cases  usually 
exhibit.  Melancholia,  as  an  idiopathic  disease,  is  the  only  form  of  insan- 
ity in  which  general  bleeding  has  appeared  to  us  to  be  useful.  In  such 
cases  we  often  open  the  vena  saphsena,  prescribe  warm  and  aloetic  pur-> 
gatives,  counter-irritation  to  the  region  of  the  stomach,  warm  bathing,, 
carriage  and  horse  exercise,  and  animal  diet. 

TREATMENT   AT   THE    PRESENT   DAY. 

The  foregoing  extracts  show  the  most  approved  treatment  of  insanity 
23 


178 

as  practiced  in  the  English  asylums  twenty-five  years  ago.  In  many 
respects  it  is  essentially  the  same  at  the  present  time.  A  few  of  the 
remedies  then  employed  have  been  laid  aside,  or  are  regarded  with  less 
favor  now,  while  a  few  others  have  been  discovered  or  brought  more 
prominently  to  notice,  and  have  been  substituted  for  them  or  given  in 
conjunction  with  them. 

General  Bleeding. 

General  bloodletting  was  not  approved  by  any  of  the  authorities  we 
have  quoted,  though  we  see  that  the  practice  was  spoken  of  as  one  too 
much  in  vogue,  and  as  detrimental  in  the  extreme.  Such  is  the  uni- 
versal opinion  of  the  physicians  at  this  time,  and  in  no  instance  nor  in 
any  form  of  insanity  was  it  recommended  by  those  with  whom  we  met 
as  a  proper  remedy  to  be  employed. 

Local  Bleeding. 

Local  bleeding,  by  cups  or  leeches,  is  still  practiced  by  some  physi- 
cians, and  regarded  with  as  much  favor  as  ever,  while  it  is  rarely 
resorted  to  b}" others,  and  therefore  not  so  generally  employed. 

Counter-irritants. 

Shaving  the  scalp,  blisters,  and  counter-irritants,  including  setons,  are 
also  less  employed  than  formerly,  while  tartar  emetic  and  digitalis  have 
become  extremely  unpopular  with  many,  and  are  now  cautiously  and 
sparingly  used  by  all. 

Baths. 

Baths  in  all  forms  seem  to  be  less  used  in  England  than  formerly,  and 
in  the  asylums  of  the  United  States  have  a  less  prominent  place  than 
they  deserve,  while  in  Italy,  the  German  States,  and  in  some  portions  of 
France  and  Holland  they  are  relied  on  as  of  paramount  importance. 
Indeed,  they  seem  to  be  the  chief  agents  employed  in  some  of  these 
countries,  and  are  administered  in  one  way  or  other  in  nearly  all  forms 
and  phases  of  the  disorder.  The  shower  bath,  the  douche,  the  plunge, 
and  continued  bath,  are  all  supposed  to  have  their  peculiar  virtues  as 
stimulants,  tonics,  or  sedatives,  and  are  used  ad  libitum  et  ad  infinitum. 
We  have  often  seen  half  a  dozen  patients  in  one  bathroom,  each  with 
the  head  only  visible,  the  body  being  immersed  in  warm  water,  and  the 
"bathtub  covered  with  a  lid  having  a  hole  in  one  end  to  fit  around  the 
neck.  Here  they  usually  remain  from  one  to  three  hours;  in  some  cases 
six  to  eight  hours,  and  in  occasional  instances  for  days  at  a  time.  Doctor 
Gudden  of  the  Asylum  at  Zurich,  in  Switzerland,  informed  us  that  he 
had  on  one  occasion  kept  a  man  thus  confined  in  a  bath  five  days.  In 
this  instance  there  was  a  high  state  of  excitement  connected  with  bed- 
sores; and  the  treatment  was  for  the  double  purpose  of  allaying  the  one 
and  relieving  the  other.  The  patient  is  represented  as  having  slept  well 
during  a  portion  of  the  time  spent  in  the  bathtub,  while  the  bed-sores 
were  entirely  healed.  The  most  remarkable  feature  in  this  case  was  the 
entire  freedom  from  exhaustion  or  any  other  evil  consequence.  We 
would  have  supposed  that  such  relaxation  of  the  physical  powers  would 
have  ensued  as  to  have  rendered  resuscitation  impossible.  We  were 
also  informed  that  in  a  case  at  Vienna,  where  a  man  had  been  scalded  by 


179 

steam,  Doctor  Hebra  had  him  placed  in  a  tepid  bath  and  kept  there  for  a 
period  of  three  wet?ks,  until  a  new  cuticle  had  formed  over  the  entire 
body.  The  patient  recovered  without  inconvenience.  This  case  was 
not  one  of  ii] sanity,  and  has  been  introduced  to  show  how  much  endu- 
rance is  i^ossessed  by  some  persons  under  peculiar  circumstances,  and  to 
direct  attention  to  this  treatment.  .  The  water,  of  course,  was  kept  of 
uniform  temperature,  and  at  such  degree  as  was  most  agreeable  to  the 
patient.  The  agonizing  pain  usually  attendant  upon  scalds  is  said  to 
have  been  effectually  overcome.  In  most  of  the  asylums  in  these  coun- 
tries there  is  a  general  bathroom  for  either  sex,  and  in  many  of  them, 
especially  Santa  Maria  della  Pieta  at  Eome,  and  St.  Ann  at  Paris,  are 
fitted  ujD  in  the  most  elaborate  manner.  In  addition  to  the  ordinary 
appliances  for  the  warm  and  vapor  bath,  the  douche,  plunge,  and  shower 
bath,  there  are  the  Turkish  and  medicated  baths,  and  a  peculiar  contri- 
vance made  with  metallic  pipes  an  inch  in  diameter,  forming  circles  like 
the  hoops  of  a  barrei.  These  tubes  are  perforated  with  innumerable 
holes  on  the  inner  side,  so  as  to  send  small  streams  of  water  under  heavy 
pressure  upon  every  inch  of  the  body  at  the  same  time.  This  the  poor 
fellow  has  to  submit  to  till  the  doctor  or  master  of  the  bath  concludes 
that  the  object  sought  to  be  accomplished  has  been  attained.  It  seemed 
to  us  a  frightful  ordeal  through  which  to  pass,  and  from  the  contortions 
and  grimaces  of  the  j^atients  we  infer  it  was  regarded  in  the  same  unfa- 
vorable light  by  them. 

At  the  Asylum  San  Yon,  at  Eouen,  presided  over  by  Doctor  Morel, 
a  writer  well  knovv^n  to  the  scientific  world,  a  man  of  ability,  and  a  wor- 
thy successor  of  Esquirol  and  other  celebrated  men  who  had  charge 
of  this  famous  old  asylum  in  bygone  days,  we  also  found  them  both 
much  emi^loyed,  and  esj^ecially  in  the  treatment  of  epilepsy.  The 
shower  bath  is  used  twice  a  day  in  these  cases,  after  which  the  patient 
is  wraj^ped  in  a  sheet.  He  reports  one  case  of  great  violence  entirely 
cured  by  this  method,  in  which  bro.  pot.  and  other  remedies  usually 
resorted  to  had  signally  failed.  He  had  also  seen  great  benefit  in  other 
cases,  and  entertained  thQ  opinion  that  no  remedy  equalled  it  with  which 
he  was  acquainted. 

There  can  be  no  question  about  the  efficacy  of  baths  in  the  treatment 
of  insanity,  when  judiciously  prescribed  and  proj^erly  administered,  but 
like  all  other  j^owerful  agents  they  are  liable  to  abuses,  by  which  they 
are  brought  into  disfavor.  Doctor  Blanche,  of  Paris,  and  Doctor  Skae, 
of  Edinbargh,  informed  us  that  after  many  years  of  persistent  and  suc- 
cessful use  of  the  warm  bath  in  the  treatment  of  acute  mania,  they  had 
been  induced  to  abandon  it  entirely,  for  notwithstanding  the  happy 
effects  derived  from  it  in  most  cases,  they  had  become  convinced  that 
several  patients  for  whom  they  liad  prescribed  the  warm  bath  had  died 
in  consequence  of  its  depressing  influence. 

We  conclude,  therefore,  that  baths,  like  most  other  valuable  agents, 
are  too  much  used  in  some  countries  and  too  little  in  others.  No  remedy 
is  so  general  in  its  effects  as  to  be  aj)plicable  to  all  cases,  and  its  failure 
to  accomplish  all  that  may  be  expected  of  it  is  no  reason  why  it  should 
be  totally  abandoned.  Chloroform  and  opium  are  sometimes  fatal  when 
administered  in  ordinary  doses,  yet  they  are  too  valuable  to  be  aban- 
doned on  this  account.  Let  us  use  all  the  remedies  of  value  that  science 
has  given  to  our  profession,  but  let  us  watch  their  effects  and  administer 
them  with  prudence. 


180 

Purgatives. 

With  regard  to  purgatives,  no  change  seems  to  have  taken  place  for 
many  years.  They  are  regarded  as  absolutely  necessary  in  certain  con- 
ditions in  all  phases  of  insanity,  the  particular  kind  to  be  employed 
being  a  mere  matter  of  taste  with  the  physician  prescribing  them.  Those 
employed  twenty-five  years  ago  are  as  much  in  vogue  to-day  as  they 
Avere  then. 

Emetics. 

Emetics  are  even  less  popular  now  than  formerly,  and  are  not  often 
administered.  Indeed,  what  we  have  said  of  tartarized  antimony  in  its 
sedative  and  other  capacities  may  also  be  said  of  it  as  an  emetic,  ^one 
of  the  emetics  are  popular  remedies  at  this  time. 

Anodynes^  Narcotics,  etc. 

Anodynes  and  narcotics,  which  have  occupied  such  a  high  place  in 
the  confidence  of  most  medical  men  who  have  been  engaged  in  the  treat- 
ment of  insanity  during  the  last  quarter  of  a  century,  are  now  being 
subjected  to  earnest  criticism  by  some,  and  almost  angry,  if  not  unrea- 
sonable, opposition  by  others.     They  are  remedies  used  in  some  form, 
though  in  various  degree,  by  nearly  all  the  Superintendents  of  asylums 
with  whom  we  have  met,  regardless  of  country  or  differences  of  opinion 
on  other  subjects.     Hence,  we  might  naturally  expect  to  find  that  they 
have  been  misused  in  Bome,  and  greatly  abused  in  other  instances.     Dr. 
Maudsley,   the   President    of   the    Psj^chological   Association   of    Great 
Britain,  in  an  able  and  interesting  address,  read  before  that  association 
August  third,  eighteen   hundred    and    seventy-one,  made  narcotics  the 
subject  of  special  notice,  and  deprecated  their  use,  in  most  cases,  in 
decided  terms,  denominating  them  the  '*  chemical  restraint,",  that  had 
been  substituted  for  the  mechanical  restraint  of  former  times.     It  was, 
perhaps,  natural  that  this  class  of  remedies  should  have  been  used  to 
excess  in  a  country  where  public  opinion  had  .been  so  much  excited  by 
and  had  waged  such  vigorous  war  against  the  employment  of  mechan- 
ical restraint — even  in  its  mildest  forms — in  any  asylum  in  the  realm. 
In  almost  every  asylum  of  ordinary  size,  there  are  a  few  patients  who 
at  times  become  so  much  excited,  and  have  such  irresistible  propensities 
to  injure  themselves   or  others— to  tear  their  clothing,   indecently  to 
expose  their  persons,  or  commit  other  equally  unreasonable  acts — that  it 
becomes  absolutely  necessary  to  restrain  them  by  some  means — mechan- 
icall}^,  if  you  choose,  by  seclusion  in  padded  rooms;  by  the  muscular 
power  of  attendants,  or  by  narcotics,  anodynes,  etc.,  the  "  chemical  re- 
straint" of  which  Dr.  Maudsley  now  complains.     Mechanical  restraint 
beino-  tabooed  by  public  opinion,  was  not  to  be  thought  of  ten  or  twenty 
years  ago.     It  would  have  cost  any  Superintendent  in  England  his  ofiicial 
head  to  have  undertaken  it,  and  let  the  fact  be  known.     Seclusion,  when 
long  continued,  is   attended  with  many  evil  results — loss   of  appetite, 
depression  of  spirits,  the  engendering  of  filthy  habits,  or  other  effects 
detrimental  to  physical  htalth  and  mental  integrity.     Attendants,  unfor- 
tunately, are  not  always  blessed  with  that  amount  of  sweetness  of  temper, 
of  untiring  j^atience,  and  unlimited  self-control,  that  will  enable  them, 
either  through  a  sense  of  duty  or  from  Christian  principles,  when  "  struck 
upon  one  cheek  to  turn  the  other,"  even  though  the  offender  be  a  lunatic. 
Hence  the  necessity,  in  England,  more  than  in  other  countries,  of  resort- 


181 

ing  to  sedatives  and  other  chemical  restraints  to  produce  the  quietness 
and  relief  that  could  not  otherwise  be  attained.  The  debate  that  Ibl- 
lowed  the  reading-  of  Doctor  ^laudslej^'s  address  revealed  the  fact  that 
all  did  not  agree  in  the  views  he  had  expressed;  but,  on  the  contrary, 
man}'-  stoutly  maintained  that  anodynes  were  among  the  most  valuable 
agents  employed  in  the  treatment  of  insanity;  while  all  admitted  that 
cases  did  occur  in  which  it  was  necessary  to  employ  them  in  some  form. 
In  such  a  discussion,  it  was  natural  to  inquire  which  of  the  many  neu- 
rotic medicines  was  best  calculated  to  accomplish  the  desired  end  with 
least  injury  to  the  patient.  Opium,  morphine,  Battley's  sedative,  hyos- 
ciamus,  cannabis  indicus,  bromide  of  2>otash,  chloral  hydrate,  and,  in  some 
Instances,  a  mixture  of  two  or  more  of  these  drugs,  ^vas  given  j^refer- 
ence.  But  the  most  remarkable  and  varied  views  were  entertained  with 
regard  to  the  effects  and  efficacy  of  the  hydro-chloral.  It  is  thou^■bt, 
by  Doctor  Ehys  Williams  and  a  few  others,  to  be  of  little  consequence 
either  one  ^vay  or  the  other.  Doctor  Browne,  of  Wakefield,  has  reported 
three  cases  of  death  from  it  ni  the  asylum  under  his  care — two  of  these 
having  occurred  the  same  daj^,  and  within  half  an  hour  after  taking 
thirty  grains  of  chloral.  AVhile  Doctor  Clouston,  of  the  Cumberland 
and  Westmoreland  Asylum,  near  Carlisle,  and  manj^  others,  have  admin- 
istered it  in  large  doses  with  no  dangerous  symptoms,  but  the  best  results. 
It  is  used  with  more  or  less  freedom  in  very  nearly  all  the  asylums  of 
Italy,  Austria,  the  German  States,  Switzerland,  and  Holland;  but  very 
rarely  in  France  and  Belgium.  Doctor  Lehman,  of  Pirna,  in  Saxony, 
gives  it  in  doses  of  from  thirty  to  one  hundred  and  twenty  grains; 
Doctor  Koeppe,  of  Halle,  in  doses  of  forty-five  to  one  hundred  and  thirty- 
five  grains;  Doctor  Guentz,  of  Thonberg,  near  Leipzig,  gives  from  forty- 
five  to  seventy-five  grains;  and  Doctor  Ludwig,  of  Heppenheim,  admin- 
isters from  thirty  to  ninety  grains,  repeating  the  dose  three  times  a  day; 
while  Doctor  Leiderdorf,  of  Doblins,  near  Vienna,  expresses  the  opinion 
that  chloral  hydrate  will  supersede  all  other  remedies  as  a  quieting  agent. 
Dr.  Professor  Ner^  of  Perugia,  Dr.  Serafino  Bifiii,  of  Milan,  Dr.  Eoller, 
of  Illenau,  and  others,  have  also  used  it,  and  express  the  highest  opin- 
ion of  it  as  a  quieting,  sleep-producing  agent.  Dr.  Eoller  thinks,  when 
long  continued,  it  has  a  tendency  to  produce  congestion  of  the  skin; 
wdiile  Dr.  Lehman  thinks  it  has  a  tendency,  under  similar  conditions,  to 
produce  stranguary;  but  as  he  also  gives  very  large  doses  of  cannabis  in- 
dicus, it  may  possibly  have  been  confounded  with  the  effects  of  that  drug. 
In  the  asylums  of  the  United  States  it  has  been  more  or  less  employed 
for  the  last  two  years,  and  the  testimony  in  its  favor  has  been  vt3ry  gen- 
eral. But  few,  if  any,  of  the  Superintendents  claim  for  it  curative  prop- 
erties, while  nearly  all  regard  it  as  one  of  the  best  hypnotics  known  to 
the  profession.  We  must  conclude,  therefore,  from  all  the  testimony  w^e 
have  been  able  to  collect  from  various  sources,  that  chloral  hydrate  is 
not  only  one  of  the  most  innocent  but  one  of  the  best  remedies  that  can 
be  used  in  most  cases  where  sleep  alone  is  the  object  desired.  We  know 
that  it,  like  most  other  remedies  of  its  class,  will  fail  to  produce  like  effects 
uj^on  all  persons;  and  it  may  be  so  much  adulterated  as  to  be  either 
worthless  or  dangerous;  and  in  no  other  way  can  we  account  for  the 
varied  results  observed  by  the  English  Superintendents.  We  have 
spoken  more  esj^ecially  of  this  remedy  because  less  is  known  of  it  by  the 
general  reader  than  almost  any  other  of  equal  importance.  We  prefer 
to  administer  it  in  twenty  grain  doses,  given  at  bedtime,  and  repeated 
every  hour  till  sleep  is  produced;  and  never  to  give  it,  or  any  other 
remedy  of  its  class,  except  w^hen  the  end  to  be  accomj^lished  is  esteemed 


182 

an  absolute  necessity.  Of  this  necessity  the  physician  must  be  the  judge 
in  each  case  as  it  presents  itself.  If  chemical  restraint  seemed  to  be  the 
proper  remedy,  we  would  use  it.  If  mechanical  restraint  should  seem 
of  more  importance  in  any  giyen  case*  we  should  not'  hesitate  to  employ 
that  instead  of  the  other;  nor  can  we  see  any  good  reason  why  the 
physician  should  be  left  with  unlimited  power  to  use  the  more  dangerous 
remedy,  while  the  other  is  entirely  prohibited.  The  camisole  or  mufi*  is 
the  only  kind  of  mechanical  restraint  that  should  eyer  be-  employed 
under  any  circumstances,  except  for  surgical  reasons,  and  these  oul}^  by 
the  order  and  in  the  presence  of  the  physician.  In  these  yiews  we  are 
confident  that  two  thirds  of  the  Superintendents  in  Great  Britain  will 
heartily  concur,  and  at  least  nine  tenths  of  those  in  other  countries,  in- 
cluding our  own.  In  truth,  we  are  disposed  to  belieye  that  mechanical 
restraint  is  too  freely  used  in  most  of  the  asylums  in  our  country  as  well 
as  on  the  continent;  and  in  this  respect  we  go  quite  as  far  wrong  in  one 
direction  as  they  do  in  England  in  the  other. 

Dr.  Morel,  of  St.  Yon,  is  one  of  the  warmest  adyocates  of  the  non- 
restraint  system  with  whom  we  met  in  all  France.  He  had  paid  a  yisit 
to  Dr.  Conolly,  at  Hanwell,  where  he  had  seen  its  practical  operations 
under  the  eye  of  the  master,  of  whom  he  was  an  ardent  admirer. 
Haying  imbibed  Dr.  Conolly's  yiews,  he  made  to  his  Goyernment  one  of 
the  ablest  reports  on  the  subject  that  we  haye  read,  and  so  thoroughly 
was  he  conyinced  of  the  propriety  and  practicability  of  the  system  that 
he  at  once  put  it  in  practice  m  the  asylum  oyer  which  he  presided,  nor 
did  he  abandon  it,  eyen  in  surgical  cases,  until  a  deformity  in  a  case  of 
fracture  of  the  leg  demonstrated  the  absurdity  of  treatino-  lunatics  and 
those  possessed  of  their  reason  alike  in  all  cases.  Had  this  patient 
been  strapped  to  the  bed  during  the  process  of  union,  this  calamity 
would  haye  been  ayoided,  and  so  it  may  be  said  of  others  of  like  char- 
acter. Hence,  Dr.  Morel  now  thinks  the  use  of  the  camisole  as  necessary 
in  rare  instances  as  any  other  remedy  intrusted  to  the  judgment  and 
discretion  of  the  physician,  nor  does  he  hesitate  to  prescribe  its  use 
when  he  thinks  the  patient  will  be  benefited,  byt  under  no  circum- 
stances does  he  permit  an  attendant  to  eniploy  it  without  his  direction. 
The  chemical  restraint,  opium,  morphine,  chloral,  etc.,  are  prescribed  by 
the  physician  only,  and  so  should  it  eyer  be  with  mechanical  restraint, 
the  camisole. 

EpUepsy. 

We  haye  seen  that  the  remedies  employed  in  this  fearful  disease  were 
principally  the  metallic  salts — nitrate  of  silyer,  oxide  of  zinc,  citrate  of 
iron,  bichloride  of  mercury,  etc.,  assisted  by  setons,  blisters,  cups,  pur- 
gatiyes,  and  anti-spasmodics — and  that  all  were  equally  unayailing. 
The  disease  is  still  considered  incurable  by  almost  all  who  haye  been 
called  upon  to  treat  it,  though  it  is  now  claimed  by  a  few  that  in  rare 
cases  among  the  young,  and  especially  in  those  cases  where  insanity 
superyenes  on  a  preyiously  existing  epilepsy,  it  is  not  necessarily  incu- 
rable, and  that,  in  a  large  majority  of  cases,  the  frequency  and  seyerity 
of  the  attacks  may  be  lessened,  thus  modifying  the  disease  and  amelio- 
rating the  unhappy  condition  of  the  patient.  AVe  haye  already-  stated  the 
treatment  by  shower  bath  pursued  by  Doctor  3Iorel,  at  San  Ton,  and. 
giyen  the  results.  Similar  claims  have  been  made  by  different  persons 
in  fayor  of  each  of  the  remedies  above  enumerated.  Thus,  Doctor 
Leiderdorf,  of  Dobling,  near  Vienna,  reports  one  case,  cured  with  ox. 
zinc;  another,  when  there  was  a  syphilitic  taint,  with  iod.  pot.     Doctor 


183 

Fiscliel,  of  the  Eoyal  Bohemian  Asj'lum  at  Prague,  attributes  the  cure 
in  one  ease  to  Fowler's  solution;  and  so  on  through  the  entire  list.  But 
the  remedy  most  used  in  the  present  day,  and  that  in  which  there  is 
most  confidence,  is  unquestionably  the  bromide  of  potassium.  It  is  given 
by  nine  tenths  of  the  proibssion  who  have  charge  of  asylums;  and  while 
but  few  ascribe  to  it  curative  powers,  most  of  them  claim  that  it  greatly 
ameliorates  the  attacks,  and  often  wards  them  off  entirely  during  its 
administration,  thus  giving  its  victims  long  intervals  of  relief  and  repose, 
while  in  a  few  instances  complete  restoration  is  effected.  It  is  given  in 
doses  varying  from  five  to  one  hundred  and  tw^enty  grains,  according  to 
the  urgency  of  the  case  and  the  peculiar  views  of  the  physician.  ISTor 
is  its  employment  confined  alone  to  the  treatment  of  epilepsy.  Some 
use  it  in  the  treatment  of  nymphomania  and  kindred  afltections,  while  it 
is  the  only  neurotic  medicine  emj^loyed  by  Doctor  Blanche  in  his  asy- 
lum at  Passy.  He  gives  fifteen  or  twenty  grains  three  times  a  day  as  a 
quieting  agent.  It  is  often  administered  in  combination  with  other  seda- 
tives, anodynes,  or  narcotics — and  is  thought  to  increase  their  efficiency, 
and  is  one  of  the  few  remedies  that  have  attained  almost  universal  popu- 
larity. 

Paralysis. 

In  the  treatment  of  this  disease  as  connected  with  insanity  but  little 
change  has  taken  place  within  a  quarter  of  a  century,  unless,  we  should 
say,  it  is  not  so  much  treated  as  formerly.  Blisters,  the  galtanic  bat- 
tery, counter-irritation  of  all  kinds,  and  the  shower  bath,  seem  to  be  less 
used  than  formerly;  while  the  only  new  remedy  employed,  so  far  as  we 
know,  is  the  ergot  of  rye,  as  prescribed  by  Doctor  Chrichton  Browne, . 
of  the  Wakefield  Asylum  in  England.  He  thinks  good  eftects  have  been 
accomplished  by  its  use,  but  sufficient  time  has  not  yet  elapsed  to  test  its 
eflScacy. 

MORAL    TREATMENT. 

The  moral  treatment  of  insanity  is  considered  of  more  importance  by 
many  persons  having  charge  of  the  insane  than  the  medical,  and  the 
tendency  to  this  opinion  seems  to  be  gradually  increasing.  It  compre- 
hends all  of  those  means  Avhich  operate  on  the  feelings  and  habits  of  the 
patient,  and  exerts  a  salutary  influence  by  tending  to  restore  them  to  a 
natural  and  healthy  condition.  The  means  to  be  employed  under  this 
heal  are  as  varied  as  the  diseases  leading  to  or  the  symptoms  develoj^ed 
by  insanity.  It  is  in  the  judicious  employment  of  the  remedies  of  this 
class  that  the  physician  and  the  attendants  are  called  upon  to  use  the 
greatest  skill  and  tact  of  which  they  are  capable,  whether  as  connected 
with  individual  cases  or  collective  numbers.  One  important  particular 
belonging  to  moral  treatment  has  been  already  alluded  to  in  our  remarks 
on  the  non-restraint  system.     The  English  Commissioners  in  Lunacy  say: 

"  There  is  nothing  moi'c  important  in  the  moral  treatment  of  the 
insane  than  the  proper  use  of  means  which  contribute  to  their  employ- 
ment, both  mental  and  bodily,  and  tend  to  withdraw  their  attention  from 
thoughts  and  feelings  connected  with  their  disordered  state." 

The  provision  made  for  the  attainment  of  these  objects  in  our  asjdums 
cannot  be  too  strongly-  recommended,  nor  insisted  upon  with  too  much 
pertinacity  by  those  whose  duty  it  is  to  watch  over  them. 

Employment  in  agricultural  labor,  in  the  vegetable  garden,  among  the 


184 

vines  and  fruit  trees,  or  in  cultivating  flovrers  for  their  amusement  and 
entertainment,  will  be  of  the  greatest  advantage  to  all  of  the  insane  who 
can  be  induced,  either  by  persuasion  or  slight  compensation,  to  partici- 
pate in  them.  The  general  health  will  be  improved  by  this  exercise 
in  the  open  air,  the  appetite  increased,  the  nervous  sj^stem  is  less  easily 
disturbed,  the  mind  more  composed,  sleep  is  sweeter,  sounder,  and  more 
refreshing,  and  the  patient,  with  less  opportunity  to  brood  over  his 
disease  or  imagined  troubles  and  wrongs,  gravitates  naturally  and  by 
degrees  into  old  habits  of  thought,  health,  and  cheerfulness;  the  equi- 
librium is  restored,  and  the  patient  is  well. 

Single  Booms. 

Another  matter  eom.ing  under  the  head  of  moral  treatment  or  manage- 
ment may  be  j)roperly  mentioned  here.  It  is  the  general  opinion, 
expressed  in  words  and  carried  out  in  practice,  that  all  excited  patients 
should  be  kept  by  themselves  in  single  rooms,  or  cells,  as  they  are  unfor- 
tunately called  throughout  Europe;  and  especially,  that  they  should  be 
80  kept  at  night.  Doctor  Morel  is  decidedly  of  the  opposite  opinion, 
and  while  he  admits  their  necessity  in  a  few  isolated  cases,  has  demon- 
strated to  his  own  satisfaction  that  the  theory  is  wrong  and  the  practice 
injudicious  in  most  instances.  He  has,  therefore,  taken  out  the  partition 
walls  between  most  of  these  cells  and  converted  them  into  dormitories, 
and  assured  us  that  where  four  noisy,  restless,  sleepless  patients  were 
formely  kept  in  single  rooms,  sixteen  were  now  passing  quiet  nights, 
sleeping  well,  and  giving  every  evidence  of  being  better  satisfied.  He 
argues  that  most  of  the  excited,  noisy  ]3atients  are  afraid  to  be  left  alone 
at  night,  and  that  this  very  fear  disturbs  their  quiet  and  prevents  them 
from  sleeping. 

Schools. 

He  has  also  recently  organized  a  class  of  excited  patients,  which  he 
examines  each  day  when  passing  through  the  wards.  Thirty  were  in 
attendance  on  the  da}^  of  our  visit,  and  we  found  them  more  quiet  and 
orderly  than  at  any  other  time.  All  would  clamor  for  the  privilege  of 
showing  how  well  they  could  read,  or  repeat  some  little  piece  of  prose 
or  verses  of  poetry  that  they  had  committed  for  the  occasion,  but  as 
soon  as  the  doctor  would  decide  who  was  entitled  to  the  floor,  all  became 
quiet  and  listened  attentively  till  the  piece  was  spoken,  when  they  would 
rise  to  their  feet  and  again  put  in  their  claims,  and  so  on  to  the  end  of 
the  recitation.  They  really  seemed  to  take  great  interest  in  these  exer- 
cises, and  doubtless  many  moments  of  comparative  happiness  were 
passed  in  learning  their  lessons  that  would  otherwise  have  been  spent  in 
miserable  contemplation  of  their  unhappy  condition.  These  schools 
have  long  existed  in  some  of  the  continental  asylums,  and  a  few  in  Great 
Britain  aud  Ireland,  though  this  was  the  first  and  only  one  we  have  seen 
especially  devoted  to  the  excited  patients.  Music,  drawing,  and  singing 
are  taught  in  most  of  the  Italian  asylums  and  in  some  of  those  in  other 
countries.  At  Aversa,  near  IS^aples,  there  is  a  regular  band,  who  play 
for  their  own  amusement  and  that  of  the  other  patients.  A  theater  has 
been  fitted  up,  in  which  they  play,  give  concerts,  and  other  entertain- 
ments; and  here,  as  at  York,  in  England,  and  Morningside,  in  Scotland,  a 
printing  press  has  been  provided,  and  the  patients  encouraged  to  write 
articles  that  are  set  up  and  printed  by  themselves.  Here,  too,  as  at 
Lyons,  in  France,  Ghent,  in  Belgium,  and  Wakefield,  England,  we  saw 


185 

many  looms,  on  which  the  patients  wove  the  cloth  used  by  the  asylums. 
At  [San  Servalo,  in  Venice,  the  band  plays  every  day  from  eleven  to 
twelve,  and  the  patients  are  as  much  delighted  as  if  at  a  regular  concert, 
while  those  who  belong  to  the  band  gave  signs  of  evident  satisfaction. 

In  some  of  the  asylums  in  Milan,  schools  have  also  been  established, 
but  we  will  only  make  an  extract  from  our  notes  of  a  visit  to  one  of 
them,  the  last  we  visited  in  Italy: 

April  od-^To-day  we  visited  the  private  asylum  of  Doctor  Serafino 
Biffi,  one  of  nature's  noblemen,  who  seems  as  generous  as  a  prince  and 
as  kind  as  a  woman,  one  of  those  real  loveable  men  with  whom  we 
sometimes  meet  in  our  journey  through  life.  The  asylum  is  a  quiet, 
homelike  place,  such  as  we  might  expect  to  grow  up  under  the  care  and 
management  of  so  good  a  man.  No  pains  l:0ve  been  spared  to  make  it 
in  reality  a  home  for  the  homeless,  and  a  retreat  for  the  heavy  hearted 
and  afflicted.  Two  teachers  are  employed,  who,  in  addition  to  other 
branches,  teach  vocal  and  instrumental  music.  They  play  and  sing  with 
as  much  accuracy  and  expression  as  if  no  illusion  or  hallucination  dis- 
turbed their  minds.  They  played  and  sang  several  pieces  and  tunes  for 
our  benefit,  and  showed  us  some  of  their  paintings  and  drawings  that 
would  have  been  a  credit  to  artists  of  no  ordinary  pretentions.  Twenty 
of  the  seventy-four  patients  in  this  asylum  were  engaged  in  these  occu- 
pations at  the  time  of  our  visit,  and  as  good  order  prevailed  as  at  any 
school  to  be  found.  Others  were  reading,  playing  billiards  or  draughts, 
while  others  still  were  promenading  about  the  beautiful  grounds. 

This,  as  we  have  stated,  is  a  private  asylum,  where  patients  are 
charged  from  sixty  cents  to  two  dollars  per  day,  and  is  not  given  as  a 
specimen  of  the  public  institutions,  which  are  greatly  inferior  to  it. 

The  most  thoroughly  organized  school  that  we  have  anywhere  seen, 
however,  was  in  the  Eichmond  Asylum,  at  Dublin.  The  sj^stem  has 
been  completely  established,  and  the  organization  as  perfect  as  any 
schools  in  the  country.  The  able  Suj^erintendent,  Doctor  Lalor,  has 
taken  great  interest  in  and  paid  particular  attention  to  the  subject, 
demon strat'ing  not  only  the  possibility  of  promoting  good  order  and 
discipline  by  means  of  schools,  but  also  of  increasing  the  knowledge 
and  improving  the  morals  of  persons  while  in  a  state  of  insanity.  There 
were  about  nine  hundred  patients  in  the  asylum  at  the  date  of  our  visit — 
August  twenty-ninth,  eighteen  hundred  and  seventy-one — more  than  a 
fourth  of  Avhom  attended  school.  In  the  school  for  males  we  saw  one 
hund. el  and  twenty  engaged  in  their  recitations  and  exercises,  which 
were  conducted  with  perfect  order  and  propriety.  Eeading,  writing, 
arithmetic,  object  lessons,  music,  drawing,  and  painting  are  taught,  and 
Doctor  Lalor  informed  us  that  considerable  advancement  had  been  made 
by  some,  while  all  had  been  benefited  in  a  moral  point  of  view;  self- 
control,  power  of  concentration,  and  regularity  of  habits  had  been 
attained  in  many  instances  where  they  had  been  totally  absent  before; 
and  that  he  regarded  the  school  as  one  of  the  chief  agencies  in  promot- 
ing good  order  and  in  establishing  a  comparative  degree  of  contentment 
and  cheerfulness  in  his  asylum.  The  school  for  females  is  conducted  on 
similar  principles,  though  needlework  is  added  to  the  list  of  studies  in 
this  department.  Six  teachers,  three  of  either  sex,  are  regularly 
employed,  at  salaries  about  double  the  amount  paid  attendants,  and  in 
addition  to  their  duties  as  teachers  are  required  to  assist  in  ''  keeping  the 
house  in  order."     Some  of  them  always  accompany  the  patients,  in  their 

24 


186 

walks  outside  the  asylum  walls,  in  the  public  park,  and  other  i)laces  to 
which  they  are  permitted  to  go.  These  teachers,  being  better  educated, 
more  intelligent,  and  of  a  higher  order  than  those  whose  services  can 
be  obtained  for  the  ordinary  wages  paid  attendants,  exercise  a  salutary 
influence  over  the  patients  at  all  times.  Their  morals,  habits,  and  man- 
ners, being  thus  cultivated  and  controlled,  are  necessarily  improved,  and 
we  confess  our  surprise  at  having  seen  this  kind  of  occupation  intro- 
duced into  so  few  of  the  asylums  of  our  own  country. 

DIRECTORS  AND  SUPERINTENDENTS. 

Unfortunately  the  custom  still  prevails  in  some  of  the  asylums  oil  the 
continent  of  placing  a  Director  at  the  head  of  the  institution.  Its  gen- 
eral mauagement,  the  powm*  to  employ  and  discharge  all  the  attaches 
and  attendants,  and  to  say  how  the  patients  shall  be  fed,  clothed,  and 
occupied,  are  invested  in  him,  though  generally  a  non-medical  man.  The 
Medical  Superintendent  occupies  a  subordinate  position.  He  of  course 
prescribes  the  medical  treatment  for  all,  and  the  diet  for  the  sick,  but  no 
other  j^owers  are  assigned  to  him.  As  may  readily  be  supposed,  this 
divided  responsibility  begets  evil  results.  The  physician  is  lessened  in 
public  estimation;  the  employe  and  attendant  look  to  the  Director  for 
his  position  or  his  place,  and  naturally  take  sides  with  him  in  any  con- 
flict of  opinion  that  may  arise.  They  place  themselves  in  antagonism  to 
the  wishes  of  the  physician,  and  but  half  carry  out  his  orders,  and  thus 
destroy  the  harmonious  workings  of  the  institution. 

In  Great  Britain  no  man  is  chosen  as  Superintendent  of  an  asylum  who 
has  not  served  as  an  assistant.  He  must  be  armed  with  recommenda- 
tions as  to  his  qualifications,  standing,  and  moral  character,  and  is  sub- 
jected to  a  searching  examination.  Having  passed  this  ordeal  and 
obtained  the  position,  he  retains  it  for  life,  unless  removed  for  cause. 
He  has  supreme  control  of  the  asylum  over  which  he  presides,  nominates 
his  assistants  and  other  ofiicers,  and  selects  his  attendants.  He  is  j^aid  a 
liberal  salary,  and  given  one  month's  leave  of  absence  each  year  for 
recreation;  and  after  serving  fifteen  years  is  allowed  an  annuity  equal  to 
three  months  of  his  salary,  provided  he  desires  to  retire  from  service. 
Harmony  is  the  result  of  this  system,  and  the  consequence  is  good  order 
and  thorough  discipline  in  every  asylum  in  Great  Britain. 

Under  these  circumstances,  men  of  the  highest  order  of  intellectual 
capacity  and  thorough  education  j^i'epare  themselves  for  the  position  of 
Superintendent,  and  being  under  a  local  Board  of  3Ianagers,  and  sub- 
jected to  periodical  visitations  by  the  Commissioners  in  Lunacy,  strive 
to  merit  their  good  opinion.  These  Commissioners  are  always  men  of 
first  class  ability,  high  character,  independence,  and  influence,  who  make 
searching  examinations,  and  comment  upon  matters  as  they  find  them, 
without  fear  or  favor,  and  are  a  power  in  the  land  that  cannot  be  ignored 
nor  disregarded. 

The  vigilance  exercised  by  the  Boards  of  Commissioners  in  Great 
Britain,  and  the  admirable  organization  above  referred  to,  make  their 
system  superior  to  any  that  elsewhere  exists,  and  should  be  adopted  in 
all  countries  with  centralized  Governments  and  circumscribed  bound- 
aries. The  form  of  our  Government,  composed  of  thirty-seven  States, 
each  managing  its  OAvn  local  aifairs  and  having  its  own  method  of  pro- 
viding for  the  insane  (even  if  the  vast  extent  of  territorial  limits  did 
not  forbid),  would  render  it  impossible  for  such  a  system  to  be  adopted 
in  the  United  States,  while  the  small  number  of  asylums  in  most  of  the 


.    187 

States  would  not  justify  the  establishment  of  Boards  of  State  Commis- 
sioners. 

In  Ireland  and  in  some  asylums  on  the  continent,  in  addition  to  the 
resident  officers,  a  Visiting  Physician  is  appointed,  who  makes  regular 
visits  and  consults  with  the  Superintendent.  The  advantages  claimed 
for  this  custom  by  the  Directors  are,  that  he  forms  a  link  between  the 
asylum  and  the  outer  world;  that  the  people  have  more  frequent  oppor- 
tunities to  converse  with  one  who  is  in  constant  communication  with  the 
patients  within;  that  they  can  make  more  frequent  inquiries  about  their 
afflicted  friends;  and  that  a  physician  engaged  in  general  practice  is 
better  prepared  to  treat  diseases  of  a  purely  physical  charactei%]ian  one 
who  has  devoted  his  time  to  the  study  and  his  energies  to  the  treatment 
of  insanity  alone. 

An  asylum  should  be  open  to  the  friends  of  patients  at  all  times, 
except  when  such  visits  might  be  thought  by  the  Superintendent  to  be 
injurious  to  the  patient;  and  even  in  this  case  the  desired  information  as 
to  his  condition  might  as  properly  be  communicated  by  the  Superin- 
tendent as  by  the  Consulting  Physician.  We  are  well  aware  of  the 
injurious  etfects  upon  the  j^atients  of  too  much  indiscriminate  visiting  by 
families  or  friends,  but  the  proi:)riety  of  these  visits  must  be  left  to  the 
discretion  of  the  Superintendent  or  other  resident  medical  officer,  and 
these  should  ever  be  accessible  to  all  who  desire  to  make  legitimate 
inquiry  as  to  the  condition,  prospects,  and  treatment  of  their  friends. 
They  should  be  the  "  connecting  link  "  mentioned  hj  our  friends  in  Ire- 
land. The  last  reason  referred  to  is  of  still  less  weight.  We  cannot 
comj^rehend  how  any  i^hysician  who  does  not  thoroughly  understand 
the  pathology  and  treatment  of  j^hysical  diseases  can  successfully  treat 
l^ersons  who  are  insane,  since  we  hold  that  all  cases  of  mental  derange- 
ment are  in  some  way  connected  with  or  dependent  upon  physical 
disease. 

ATTENDANTS. 

To  accomplish  the  best  results,  however,  in  addition  to  a  skillful  med- 
ical staff  and  proper  hospitals  it  is  all-important  that  intelligent,  patient, 
and  self-sacrificing  attendants  should  be  procured;  those  who  will  not- 
only  be  attentive  to  their  duties,  but  are  kind  and  cheerful  in  disposition, 
and  who  are  j)ossessed  of  tact  and  discriminating  judgment. 

For  these  reasons,  liberal  wages  should  be  paid,  and  a  system  of 
rewards  established  for  those  who  are  faithful  to  their  trust  and  con- 
tinue in  the  service.  Eeasonable  leave  of  absence  should  be  given  at 
regular  intervals  to  admit  of  visits  to  family  or  friends,  and  comfortable 
quarters  provided,  that  proper  rest  may  be  procured  and  contentment 
prevail.  Seeing  that  their  comforts,  happiness,  and  interests  are  not 
overlooked,  they  will  become  interested  in  the  duties  assigned  them  and 
in  the  general  welfare  of  the  institution  with  which  they  are  identified. 

In  some  asylums  in  this  country  and  in  Europe  the  wages  of  attend- 
ants are  regularly  increased  for  a  given  number  of  years,  and  in  some  of 
those  in  England  and  on  the  continent  an  annuity  is  allowed  after  a  con- 
tinuous service  of  fifteen  years.  These  are  all  good  features  that  may 
Avell  be  considered  in  the  organization  of  a  hospital  for  the  insane,  as 
nothing  is  more  detrimental  to  the  harmonious  management  of  an  asy- 
lum than  inefficient  and  constantly  changing  attendants.  The  best 
authorities  agree  that  there  should  be  at  least  one  attendant  for  every 
ten  patients;  and  we  are  thoroughly  convinced  that  the  number  has  not 
been  placed  too  high,  for  though  some  classes  of  patients  require  less 


188 

than  this  proportion,  others  need  more,  and  cannot  be  i)roperly  treated 
or  managed  without  them. 

We  also  observed  in  a  few  of  the  English  asylums  a  man  and  wife 
acting  as  attendants  in  the  wards  for  intirm  men,  and  learned  from  the 
Superintendents  w^ho  had  adopted  the  system  that  it  gave  great  satisfac- 
tion to  the  patients,  and  always  added  to  the  neatness  and  cheerfulness 
of  the  wards.  That  the  restraining  influence  of  woman  and  the  sooth- 
ing effects  of  her  tender  care  were  as  ajDparent  among  the  insane  as 
among  sane  men;  and  if  this  be  true,  all  will  admit  the  propriety  of  the 
system.  ^  For  ourself,  we  would  at  anytime  rather  be  nursed  by  one 
woman  than  ten  men,  and  in  this  respect  we  probably  agree  with  all 
classes  of  our  fellow  men. 

We  have  thus  given  a  brief  synopsis  of  the  treatment  of  insanity  and 
the  management  of  insane  persons,  as  practiced  in  some  of  the  best  asy- 
lums in  most  of  the  enlightened  countries  of  the  world;  and  it  may 
fairly  be  presumed  that  the  medical  men  who  have  charge  of  them  are 
among  the  most  able  and  learned  of  the  profession  to  which  they  belong. 
From  this  we  hoj^e  the  non-professional  reader  may  be  able  to  form 
some  idea  of  the  methods  of  general  treatment  ordinarily  adopted  in 
the  usual,  forms  of  insanity.  No  specific  treatment  can  be  laid  down 
that  would  be  applicable  to  the  same  class,  as  this  must  vary  with  the 
peculiarities  of  each  case.  But  we  desire  to  impress  this  important  fact 
upon  the  public  mind,  that  "insanity  is  a  disease  of  the  brain  affect- 
ing the  mind,"  and  that  an  asjium  is  nothing  more  than  a  hospital 
adapted  to  the  treatment  of  this  peculiar  malady;  that  patients  commit- 
ted to  its  care  will  be  skillfully  treated  and  kindly  nursed,  and  that  if 
sent  in  the  early  stage  of  the  disorder  a  large  majority  will  be  restored 
to  health  and  to  reason. 


CHAPTEE   XIY. 
IXSAXITY   IX    GEXERAL. 


Increased  attention  to  Insanity-— Growth  of  Hospitals  in  United  States — Increase  of  Hos- 
pitals in  United  States — Increased  Accommodation — Hospitals  exhibit  Insanitj^ — Non- 
residents— Should  other  States  send  their  Insane  to  California— Insanity  in  other  States 
— Results  of  Treatment— Curability  of  the  Insane — Effects  of  Earl}'  Tieatment — Good 
Hospitals  necessary  to  Favorable  Results — Results  in  our  Asylum — Doubtful  and  Hope- 
less Cases — Econoni J' of  Early  Treatment — Probable  Duration  of  Life  in  Chronic  Cases 
—Increase  of  Patients  in  our  Asylum— Causes  tending  to  this  Result — AVill  the  Chil- 
dren of  Foreigners  be  as  liable  to  Insanity  as  their  Parents — Observations  upon  Phys- 
ical and  Moi-al  Causes  producing  Insanity — Intemperance  a  Leading  Cause  of  Insanity 
—Duty  of  State  relative  to  Asylums— Physicians  not  generally  Informed  on  the  Sub- 
ject of  Insanity — Ps3'chology  recommended  to  be  Taught  in  Medical  Schools — Effect 
of  the  Liberal  and  of  the  Economical  Plan  of  Care  and  Treatment. 

INCREASED  ATTENTION  TO  INSANITY. 

From  the  foregoing  considerations,  derived  from  various  sources  and 
authorities,  setting  forth  the'  history  of  insanity,  the  receptacles  in 
wdiich  the  lunatics  were  kept,  and  the  methods  of  treatment  pursued 
towards  them,  we  learn  that  it  is  only  within  a  century  that  it  dawned 
upon  the  world  that  lunacy  Avas  curable  in  any  considerable  degree. 
The  doctrine,  however,  made  very  slow^  j^rogress  and  but  few  converts. 
Even  in  the  beginning  of  this  century,  hospitals  were  built  to  give  to 
the  insane  a  more  humane   confinement  than  the  prisons  in  which  they 


189 

had  been  kept  could  afford;  and  it  was  not  till  within  the  recollection  of 
many  now  living  that  the  faith  in  the  curability  of  the  disease  became 
general,  even  among  professional  men.  Ileneo,  hospitals  began  to  be 
built  for  the  twofold  purpose  of  custody  and  curability,  for  beside  the 
difficulty  of  managing  and  taking  care  of  lumitics  at  home,  it  was  found 
that  comparatively  few  recovered.  From  this  period  hospitals  began  to 
be  regarded  as  not  only  the  best,  but  to  most  persons  the  only  place  for 
the  insane.  Hence  an  increasing  denumd  for  their  accommodation,  and 
though  their  numbers  have  multiplied  with  astonishing  rapidiiy,  and 
have  greatly  increased  in  size,  they  are  still  inadequate  for  the  recep- 
tion and  accommodation  of  all  who  knock  at  their  doors,  and  with 
j^iteous  appeals  seek  admission  for  the  treatment  they  afford  and  the 
benefits  tliey  are  known  to  confer.  At  the  beginning  of  this  century 
there  were  only  four  recej^tacles  for  the  insane  in  the  United  States,  and 
only  one  of  these,  that  at  VYilliamsburg,  Virginia,  devoted  exclusively  to 
the  treatment  of  insanity.  Previous  to  its  establishment,  however,  in 
seventeen  hundred  and  seventy-three,  a  ward  had  ..been  set  apart  for 
their  accommodation  in  the  Pennsylvania  Hospital,  and  contained  eigh- 
teen patients  as  early  as  seventeen  hundred  and  fifty-two.  Similar  insti- 
tutions followed  in  seventeen  hundred  and  ninety-seven — the  Maryland 
Hospital,  at  Ealtimore,  and  the  Bloomingdale  Asylum,  at  New  York. 
But  little  attention,  however,  had  yet  been  paid  to  this  subject,  and,  as 
will  be  seen  from  the  following  table,  no  other  asylum  was  established 
till  eighteen  hundred  and  seventeen,  when  the  Friends  opened  one  at 
Frankford,  near  Philadelphia,  followed  the  year  after  by  the  McLean 
Asylum,  at  Somerville,  Massachusetts. 

GROWTH    OF    HOSPITALS    IN    UNITED    STATES. 

Showing  date  of  establishment  of  the  following  Asylums,  loith  a  list  of  those 

in  process  of  erection. 

^  The  following  hospitals  first  received  insane  patients  before  the  year 
eighteen  hundred: 


Philadelphia,  Penn.,  Hospital.. 1752 
Williamsburg,  Ya.,  established 
at  that  time 1773 


Baltimore,  Md 1797 

Bloomingdale.  K  Y 1797 


Asylums  Established  between  1800  and  1820. 

Frankford 1817  |  McLean 1818 

From  1820  to  1830, 


Bloomingdale 1821 

Columbia,  S.  C 1822 

Lexington,  Ky 1824 


Hartford,  Conn 1824 

Staunton,  Ya 1828 


From  1830  to  1840. 


Worcester,  Mass 1833 

Baltimore,  Md 1834 

Brattleboro,  Yt 1837 


Columbus,  Ohio,  destroyed  by 

fire 1839 

Boston,  Mass 1839 


190 

From  1840  to  1850. 


Xashville,  Tenn 1840 

Augusta/Me 1840 

Philadelphia,   Penn.,   Hospital 

for  Insane 1841 

Concord,  N.  H 1842 

Milledo-eville,  Ga 1842 

mica,^]S\  Y 1843 


Insane    Department  of  Phila- 
delphia Almshouse 1845 

Flushing 1846 

Providence,  E.  1 1847 

Indianapolis,  Ind 1848 

Jack  son,  La 1848 

Trenton,  X  J 1849 


From  1850  to  1860. 


Jacksonville,  111 1851 

Fulton,  :yj:o 1851 

Harrisburg,  Pa 1851 

Stockton,  Cal 1852 

Lono'view,  O ". 1853 

Madison,  Wis 1854 

Taunton,  Mass 1 854 

Hopkinsville,  Ivy 1854 

Jackson,  Miss 1855 

Flatbush,  L.  1 1855 

Canandaigua,  N.  Y 1855 


Dayton.  0 1855 

AYashington,  D.  C 1855 

Dixmont,  Pa 1856 

Paleigh,  N.  C 1856 


Auburn,  N.  Y. 


.1858 


St.  Vincent,  Mo 1858 

]S"orthampton,  Mass 1858 

Kalamazoo,  Mich 1859 

Troy,  N.  Y 1859 

0 1859 


New  burgh 


From  1860  to  1870. 


Kellyville,  Pa 1860 

Tuscaloosa,  Ala 1861 

Mt.  Pleasant,  Iowa 1861 

Blaekwell's  Island,  K  Y 1861 

Philadelphia  City  Asylum 

Immigrant,  N.  Y 1861 

Austin,  Texas 1861 

St.  Peter,  Minn 1866 


Portland,  Or 1869 

Weston,  W.Ya 1866 

Ossawatamie,  Kansas 1866 

Mt.  Hope  Petreat,  Md 1867 

Alameda  Park,  Cal 1867 

Middletown,  Conn 1868 

St.  Louis,  Mo 1869 

Ovid,  N.  Y 1869 


From  1870. 


Howard  Grove,  Eichmond,  Ya 1870. 


ASYLUMS    IN    PROCESS    OF    ERECTION. 


Anna,  111. 
Elgin,  111. 

Independence,  Iowa. 
Catonsville,  Md. 
Towsontown,  Md. 
Ward's  Island,  N.  Y. 


Poughkeepsie,  N.  Y. 
Columbus,  O. 
Athens,  O. 
Danville,  Pa. 
Buffalo,  N.  Y. 
Middletown,  N.  Y. 


ESTABLISHMENT    OF    ASYLUMS    IN    THE    BRITISH    PROVINCES. 


Toronto 1841 

Quebec 1848 


St.  John,  K  B 1848 

Halifax,  K  S 1859 


During  the  next  ten  years,  eighteen  hundred  and  tw^enty  to  eighteen 
hundred  and  thirty,  the  Bloomingdale  Asylum  was  rebuilt,  and  four 


191 

others  added  to  the  list.  During  the  next  ten  years  a  like  number  were 
built,  but  it  was  not  till  after  eighteen  hundred  and  forty,  about  the  time 
the  mind  of  the  English  public  was  directed  to  the  abuses  existing  in 
the  asylums  of  that  country,  and  the  heroic  efforts  of  Doctor  Ilill, 
Charlesworth,  and  Doctor  Conolly  to  abolish  the  vile  and  cruel  custom 
of  confining  nearly  all  patients  sent  to  asylums  with  chains,  handcuffs, 
and  the  straight  jacket,  had  been  crowned  with  success,  that  a  general 
interest  in  the  subject,  and  a  corresponding  impetus  was  given  to  the 
erection  of  asylums  in  this  country.  And  as  the  result  we  see  that 
during  the  next  ten  years  eleven  asylums  were  built.  In  the  ten  years 
that  followed  twenty-one  were  established;  till  to-day,  as  we  see  h'om. 
the  table,  no  less  than  sixty-six  asylums  in  perfect  operation,  accommo- 
dating seventeen  thousand  seven  hundred  and  thirty-five  patients,  exist 
in  the  United  States,  to  say  nothing  of  twelve  others  in  process  of  erec- 
tion. Some  of  these,  in  architectural  elegance,  completeness  of  design, 
convenience  of  arrangement,  adaptation  to  the  purposes  for  which  they 
are  intended,  and  beauty  of  location,  are  unsurpassed,  if  indeed  they  are 
equalled  by  any  institutions  in  the  world. 

SHOWING   INCREASE    OF    HOSPITALS    IN    THE    UNITED    STATES. 


? 

!z! 

!z! 

^ 

> 

^ 

s  c 

< 

2^  o 

"^ 

a 

=;-q 

B 

2 

3  2  o 

r 

1 

§ 

o 
1-^ 

o 

K 

1 

a 

i%^ 

YEAK. 

M 
S 

? 

2_ 

^  Km 

a 

3 

O                                t. 

< 

O   3 

Q 

f 

1 

1844 

17,069,453 
23,191,876 
31,44^-S'^^^ 

*17,457 

23 

2,.561            ] 
4  730           ] 

Lll 

14.67 

1850 

15  610 

28 

L68 

30  30 

1860 

23,999 
37,382 

50 

1-8,500            ] 
17,735           1 

L70 

35.42 

1870 

38,5 

55,983 

m 

>G8 

47.44 

It  is  not  in  our  country  alone,  however,  that  this  increased  attention 
has  been  paid  to  the  requirements  of  these  unfortunate  people.  We  have 
already  pointed  out  this  fact  with  regard  to  Germany,  and  we  might  do 
so  for  every  country  we  have  visited* — France,  Italy,  Belgium,  Holland, 
Ireland,  Scotland,  and  Canada — but  will  be  satisfied  with  a  table  setting 
forth  this  progress  in  the  United  States  and  England,  as  specimens  of 
the  whole: 


*  Including  idiots,  as  these  two  classes  were  not  separated  until  the  census  of  eighteen 
hundred  and  fifty. 

t  See  Journal  of  Insanity,  Yol.  XYIII,  p.  2. 


192 


Table, 

Showing  the  per  cent  of  the  Insane  provided  loith  Hospital  Accommodation  in 
the  United  States  and  England  at  different  periods. 


UNITED  STATES. 

ENGLAND. 

H 

_g1 

1      H 

1      '^ 
1      ^ 
1       : 

=■? 

Propoi 
sano 
hosp 
mod 

o  2 

^"^-{L   '^ 

1 

J3 

S  2 

<-  "p^  '^-  <-+ 

a  ^ 

r«    >i 

H-s*  c  s- 

■D    3 

3^ 

§-:§§ 

i 

s 

g2= 

o 
^ 

/■   t^ 

;  F^as. 

o 

r  M 

;  gay. 

o 

'-*5 

L  2 

:    S 

In- 
with 
com- 

C 
-b 

':    1 
:    5 

1850 

15.610 

4,730 

30.30 

1 

1   1847 

26,516 

13,832 

52.00 

1860 

23,999 

8,500 

35.42. 

1857 

33,791 

21,344 

63.00 

1870 

37,382 

17,735 

47.44 

1867 

1 

49,082 

31,914 

67.00 

INCREASED    ACCOMMODATIONS. 

From  the  above  table  it  will  be  seen  that  of  the  whole  number  of  luna- 
tics in  England  in  eighteen  hundred  and  forty-seven,  fifty-two  of  every 
hundred  were  provided  with  asylum  accommodation;  and  in  eighteen 
hundred  and  sixty-seven,  sixty-seven  per  cent  were  j^i'ovided  for.  In 
eighteen  hundred  and  fifty,  the  asylums  in  the  United  States  accommo- 
dated only  thirty  per  cent,  and  in  eighteen  hundred  and  seventy,  forty- 
seven  per  cent.  As  rapidly  as  insanity  has  appeared  to  increase  in  these 
countries  within  the  twenty  years  specified,  this  shows  that  the  pro- 
visions made  for  the  care,  comfort,  treatment,  and  restoration  of  its  vic- 
tims have  outstripped  it  by  fifteen  per  cent  in  England,  and  in  the 
United  States  by  seventeen  per  cent. 


*As  given  in  the  reports  of  the  Commissioners  in  Lunacy,  including  idiots. 


193 


H 

E! 

Under  throe  months.. 
Three  to  nx  months- 
Six  to  tv,'clvo  months. 

One  to  two  j-ears 

Over  two  years 

Unknown 

Period  under  Treat- 
ment of  Patients 
who  PiGcovored. 

to 

1  liSI§ 

••a|i;mo^.[ 

o  '-^ 

1  : 

l^iox 

mmm 

ai«K 

j                00^ 

1 

5 

^mmi 

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bi  to  tv:.  Ci  en  --; 

j  ^==gsrl 

0I^IV[ 

1^1 

IP 

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H 

2 

S     i    Soo^^c. 

•■eiKwo,,[ 

i    ^^33Sc. 

IB?ox 

1^ 
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^imi 

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1   :  ti;±^^S 

•aiBmoj 

s 

ie?ox 

1 

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1 

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■OlXilUQ^Cf 

CO 

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iiiSIS 

IG^OX 

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25 


194 

Although  this  table  does  not  show  that  ninety,  nor  even  eighty  per 
cent  have  been  restored  in  those  cases  treated  within  twelve  months 
after  the  accession  of  the  disease,  it  does  show  that  of  all  the  recoveries 
more  than  seventy-eight  per  cent  were  cured  within  that  period,  and 
that  less  than  twenty-two  per  cent  were  cured  where  the  treat- 
ment was  commenced  after  the  disease  had  existed  more  than  one  year. 
It  is  the  experience  of  the  Southern  Lunatic  Asylum,  of  Ohio,  that  only 
seventeen  per  cent  get  well  where  the  treatment  has  been  deferred  for 
two  years  and  over,  and  in  some  other  asylums  that  only  eight  per  cent 
recover  under  such  circumstances.  Let  us  add  to  the  large  percentage 
of  recoveries  of  those  treated  in  the  early  stages  of  this  malady,  the 
usual  number  of  deaths  occurring  in  asylums,  and  it  is  quite  certain 
that  a  small  proportion  only  would  remain  as  chronic  cases  to  be  sup- 
ported by  the  State  during  the  remainder  of  their  days,  which,  as  will 
presently  appear,  is  about  seventeen  years. 

GOOD    HOSPITALS    NECESSARY    TO    FAVORABLE   RESULTS. 

These  results,  of  course,  can  only  be  expected,  under  the  most  favor- 
able circumstances,  when  all  of  the  conveniences,  comforts,  and  ap- 
pliances of  the  most  approved  hospitals  and  the  best  medical  treatment 
are  brought  to  bear  upon  the  disease.  It  is  hopelessly  impossible  for 
any  amount  of  care  and  attention,  any  degree  of  medical  skill  that  the 
power  of  man  can  supply,  to  overcome  the  disadvantages  and  drawbacks 
of  a  poorly  constructed'^hospital,  vrith  its  ill  ventilated  and  overcrowded 
wards,  where  proper  classification  and  necessary  sanitary  regulations 
cannot  be  fully  carried  out,  such,  unfortunately,  as  are  some  of  the 
wards  in  our  own  asylum.  But  notwithstanding  all  of  these  drawbacks 
and  disadvantages,  the  percentage  of  cures  to  admissions  is  surpassed 
by  a  few  only  in  any  country. 

RESULTS    IN    OUR   ASYLUM. 

In  eighteen  hundred  and  seventy  there  were  but  few  asylums  in  the 
United  States  that  showed  so  large  a  percentage  of  recoveries,  while 
the  average  in  all  is  far  below  ours.  This  may  be  accounted  for  in  a 
measure  from  the  fact  that  a  large  majority  of  the  patients  are  sent  to 
our  asylum  at  an  early  period  after  the  accession  of  the  disease,  while  it 
is  yet  within  reach  of  the  physician's  skill;  and  none  can  doubt  that  the 
same  amount  of  care,  watchfulness,  and  skillful  treatment  in  a  better 
arranged  and  less  crowded  hospital  would  largely  augment  the  per- 
centage of  cures  and  lessen  the  percentage  of  deaths.  They  are  sent 
to  the  asylum  at  an  earl}^  period  because  it  is  not  only  kn"own  that  they 
will  be  received,  but  kindly  and  skillfully  treated,  and  that  the  chances 
of  recovery  are  greatly  in  their  favor.  The  ver}^  character  of  the  popu- 
lation, too,  leads  in  some  degree  to  this  result.  Many  are  without  homes 
and  families;  but  few  are  blessed  with  kind  and  steadfast  friends  to 
look  after,  watch,  and  nurse  them  when  the  evil  day  comes,  and  as  there 
is  no  other  place  for  them  the}^  are  sent  to  the  asylum,  fortunately  for 
them,  in  time  to  be  treated  while  there  is  yet  hope  of  recovery.  Lnder 
these  circumstances  a  large  number  get  well  and  are  restored  to  society' 
and  the  State.  But,  as  already  stated,  under  more  favorable  conditions, 
with  a  hospital  less  crowded  and  better  ventilated  than  man}^  of  the 
wards  in  our  asylum  are,  with  facilities  for  proper  classification,  and 
where  there  are  not  so  many  for  the  medical  officers  to  watch  and  pre- 


195 

« 

Hcribc  for,  a  much  larger  .number  would  recover.  Abundant  evidence 
lias  been  adduced  in  another  j^lace  to  show  that  large  asylums  are  not 
considered  the  best  in  any  point  of  view — neither  for  curative  purposes 
nor  on  economical  grounds;  the  latter  being  the  only  argument  that  has 
ever  been  brought  forward  to  justify  large  establishmerits  for  the  treat- 
ment of  the  insane. 

DOUBTFUL   AND    HOPELESS    CASES. 

^Ye  are  fully  aware  that  many  cases  of  insanity  are  incurable  from 
the  beginning.  The  very  causes  producing  it  places  recovery  bej^ond 
the  bounds  of  probability,  if  not  of  possibility.  Thus,  when  apoplexy, 
palsy,  or  consumption,  epilepsy,  or  even  masturbation  is  the  cause  pro- 
ducing mental  alienation,  there  is  but  little  hope,  and  all  who  have  been 
deprived  of  treatment  for  more  than  two  years  liave  forfeited  their  best 
chances  of  recovery  and  gone  within  the  limits  of  chronic  insanity, 
from  which  but  few  return  with  inental  integrity.  Fortunately,  there  is 
not  a  large  proportion  of  these  committed  to  our  asylum,  and  had  the 
oft  repeated  recommendations  of  our  Superintendent  been  heeded  by  our 
legislators  the  accumulated  numliers  would  not  have  reached  such 
appalling  proportions. 

SOME    SELF-LIMITED,    BUT    MOST   REQUIRE   TREATMENT. 

While  the  cases  we  have  been  considering  are  of  such  a  hopeless 
character,  others  appear  to  be  self-limited,  and  if  left  to  themselves  or 
removed  from  exciting  causes  and  disturbing  influences  will  recover. 
But  far  the  greater  number  require  treatment,  medical  and  moral.  In 
most  instances  this  can  only  be  accomplished  in  hosj)itals.  Men  of  dis- 
ordered mind,  when  they  need  a  change  of  air  or  scene,  cannot  go  to  a 
hotel  or  2:)rivate  boarding  house,  or  even  to  the  house  of  a  friend,  w^hen 
they  are  so  fortunate  as  to  have  the  one  or  possess  the  means  to  com- 
mand the  other.  They  require  more  caution,  forbearance,  and  oversight 
than  those  who  are  mere  invalids  suffering  from  ordinary  diseases. 
Many  of  them  are  suspicious,  and  annoying  to  those  about  them,  and 
dangerous  to  themselves  and  others.  They  must  therefore  go  to  hos- 
pitals, places,  or  people  devoted  to  their  care,  and  jirepared  to  give  them 
the  needful  attention  and  watchfulness.  But  hospitals  are  too  expensive 
to  be  provided  even  by  the  rich,  while  a  large  majority  are  jDOor  or 
entirely  destitute.  It  is  therefore  the  duty  of  the  State  to  provide  these 
hospitals,  that  all  may  receive  the  early  treatment  so  essentially  neces- 
sary to  their  restoration,  not  only  that  they  may  cease  to  be  a  burden 
upon  the  State,  but  that  they  may  return  to  it  and  to  society  the  benefits 
of  their  labor  and  usefulness. 

ECONOMY    OF    EARLY    TREATMENT. 

To  show  more  clearly  the  economy  of  early  treatment,  the  •following 
table  has  been  prepared  and  introduced.  It  shows  that  of  all  the  cures 
efl'ected  in  the  Worcester  Hospital  during  a  period  of  fifteen  years,  those 
treated  during  the  first  year  of  the  attack  required  an  average  of  five 
months  and  ten  days;  while  all  who  recovered  whose  treatment  com- 
menced after  the  expiration  of  one  year,  required  to  be  treated  ten 
months  and  ten  days — showing  conclusively  that  it  cost  the  State  only 
half  as  much  to  cure  the  earlier  cases.     And  when  it  is  considered  that 


196 

more  than  three  times  as  many  of  those  treated  in  the  early  stages  got 
well  than  of  those  treated  at  a  later  period,  it  will  be  seen  that  the 
advantages  of  the  former  are  immense. 

Let  US  add  to  this  the  large  proportion  of  those  who  never  recover 
when  treatment  is  postponed"  and  who  consequently  are  added  to  the 
chronic  list  to  be  maintained  through  life,  and  some  idea  of  the  advan- 
tages of  early  treatment  may  be  comprehended  by  the  dullest  mind. 
The  table  also  shows  that  the  average  duration  of  treatment  in  those 
who  died  during  this  period  was  four  years,  three  months,  and  twenty- 
two  days. 

Table, 

Showing  the  duration  of  Insanity  of  those  icho  recovered  in  the  Worcester  Hos- 
pital from  1833  fo  1848. 


^     i 

Duration  of  In- 

1    ' 

sanity  previ- 
ous to  Admis- 

2. 

sion. 

^     {  Total  Duration    Average  Dura- 
of  Insanity.  tion. 


One  year  or  less.   1,179 
More  than  one 

year j     201 

Unknown i       41 


855 
1,181 


Total  Time  in    Average  Time 
Hospital.       I     in  Hospital. 


25 


10 


523 

173 
33 


g 

u 

H 

g 

O 

Si 

o 

3 

«<3 

S 

^ 

^ 

• 

10 

29 



5 

10 

] 

7 

2 

10 
9 

10 

Q 

'H 

Duration  of  Insanity  of  those  ivho  Died. 


No.  Cases. 

Years. 

Months. 

1                     j 

Days.             Years.      |     Months. 

1 

i                       1 

Daj^s. 

272 

1,171          :                 5 

I 
i 

29                4 

3 

22 

Probable  Duration  of 

Life  in  the  Incurable  Insane. 

Males. 

Females. 

Average  Duration  of  Life. 

Age. 

Insane. 

Sane. 

20 

21.31 

28.66 

24.99 

36.32 

30      • 

20.64 

26.33 

23.46 

34.54 

40 

17.65 

21.53 

19.59 

23.46 

50 

13.53 

17.67 

15.60 

19.59 

60 

11.91 

12.51 

12.21 

15.60 

Averae'e 

16.74  • 

29  years. 

197 

PROBABLE   DURATION    OF    LIFE    IN    THE    CHRONIC    CASES. 

This  tabic  shows  the  probable  duration  of  life  in  the  incurable  insane 
to  be  about  seventeen  years,  while  that  of  the  sane  of  similar  ages  is 
twenty-nine  years.  This  is  doubtless  as  applicable  to  California  as  to 
Massachusetts  and  other  countries,  and  will  enable  us  to  estimate  with 
tolerable  certainty  the  length  of  time  we  will  have  to  support  a  large 
majority  of  those  in  our  asylum  at  the  present  time,  as  w^ell  as  to  appre- 
ciate the  great  difference  between  the  cost  of  cure  and  the  burden  of 
maintenance. 

INCREASE    OF    PATIENTS    IN    OUR    ASYLUM    IN    TEN    YEARS. 

During  the  last  ten  years  the  average  annual  admissions  in  our  asylum 
has  been  three  hundred  and  fifty-eight,  and  the  average  annual  increase 
sixty-seven.  In  eighteen  hundred  and  sixty  every  fifteen  hundred 
and  thirty-two  inhabitants  of  the  State  furnished  one  insane  person 
from  their  numbers,  and  in  eighteen  hundred  and  seventy  every  nine 
hundred  and  sixty-four  furnished  a  lunatic;  or  an  average  of  one  in 
twelve  hundred  and  forty-eight  for  each  year  from  eighteen  hundred 
and  sixty  to  eighteen  hundred  and  seventy.  This  is  an  annual  increase 
of  twelve  and  six  tenths  per  cent.  Since  the  asylum  was  opened 
in  eighteen  hundred  and  fifty-one,  there  have  been  admitted  five  thou- 
sand six  hundred  and  eighty-one  patients,  of  whom  forty- seven  and 
sixty-eight  one  hundredths  per  cent  were  cured,  nine  and  sixty-eight 
one  hundredths  per  cent  Avere  discharged  or  removed  uncured,  twenty- 
three  and  forty-six  one  hundredths  per  cent  died,  and  nineteen  and 
eighteen  one  hundredths  per  cent  remain,  most  of  whom  must  be  left  as  a 
charge  upon  the  Treasury  during  the  rest  of  their  days.  This  is  indeed 
a  serious  state  of  things,  and  behooves  us  seriously  to  look  the  facts  in 
the  face,  endeavor  to  find  the  causes,  and  if  possible  devise  means  to 
arrest  the  progress  of  this  fearful  malady  ere  it  gets  beyond  our  power 
to  control  it.  In  eighteen  hundred  and  forty-six,  according  to  tables 
prepared  by  Doctor  Campbell,  of  New  South  Wales,  there  was  in  that 
colony  one  insane  person  to  eleven  hundred  and  "fifteen  inhabitants,  at 
the  next  census  one  to  four  hundred,  and  in  eighteen  hundred  and  sixty- 
seven  the  proportion  had  risen  to  one  in  three  hundred  and  eighty-seven. 
This  more  nearly  approximates  the  increase  in  California  than  that  in 
any  other  country;  and  as  there  are  many  points  of  resemblance  be- 
tween the  two,  it  will  be  well  to  note  what  observers  there  have  said  in 
regard  to  the  subject.  Doctor  Norton  Manning,  who  was  apj^ointed  by 
that  Government  to  make  an  investigation  similar  to  the  one  in  w^hich 
w^e  have  been  engaged  in  behalf  of  California,  made  to  his  Government 
one  of  the  most  able,  comj^lete,  and  interesting  reports  that  we  have 
seen.  A  synopsis  of  this  valuable  document  will  be  found  in  this  report. 
On  the  increase  of  insanity  he  uses  the  following  language: 

"  This  increase  is  to  a  great  extent  accounted  for  by  the  growth  of  a 
large  mass  of  chronic  insanity,  which  perhaps  even  yet  has  scarcely 
reached  its  limits.  In  the  earlier  emigrant  days  of  the  colony,  notwith- 
standing, as  has  been  said  by  an  authority  on  this  subject,  that  every 
emigrant  ship  brought  one  or  two  either  insane  or  soon  to  become  so, 
the  vast  mass  of  the  population  came  in  the  prime  of  mental  and  bodily 
health.  Their  sick  had  been  left  behind  in  their  fatherland.  It  would 
necessarily  take  some  years  for  those  becoming  insane  and  remaining 


198 

incurable  to  grow  old  within  the  rcSjlum  walls,  and  reach  by  accumula- 
tion to  that  number  of  old,  chronic,  and  incurable  cases  with  Avhich  all 
other  countries  are  burdened.  It  may  be  fairly  estimated  that,  if  the  full 
extent  of  increase  from  this  cause  has  not  already  been  reached,  it  must 
soon  be  so,  and  that  the  number  of  removals  by  death  will  reach  the 
proportionate  number  of  yearly  entries  on  this  greater  chronic  list,  and 
so  a  balance  will  be  effected.  Tpon  the  whole,  then,  though  the  con- 
temi^lation  of  this  mass  of  suffering  humanity  must  occasion  deep  sorrow, 
the  Colony  of  New  South  "Wales  has  cause  for  a  feeling  of  satisfaction 
on  estimating  the  number  of  its  lunatic  population.  With  some  causes 
in  addition  to  those  existing  elsewhere,  the  ratio  of  its  insane  to  popu- 
lation is  not  now  markedly  above  that  in  most  of  those  countries  where 
the  numbers  have  been  ascertained  with  even  tolerable  exactness.  These 
special  causes  will,  it  is  to  be  expected,  gradually  disappear;  the  convict 
element  will  become  fainter;  the  excitements  of  life  will  diminish;  it 
may  fairly  be  hoped  that  the  use  of  poisonous  alcoholic  compounds,  also,^ 
will  decrease  with  the  increase  in  quantity  and  diminution  in  price  of 
wholesome  colonial  wine  and  beer,  as  well  as  under  the  better  moral 
feelings  of  the  future.  AYith  the  diminution  of  these,  the  special  causes 
of  insanity  in  older  countries  may  make  their  appearance;  but  it  can 
scarcely  be  supposed  that  the  ratio  of  insanity  will  rise  higher  than  at 
present.  A  ratio  equal  to  this,  though  the  burden  is  great,  is  borne 
cheerfully  by  States  not  more  wealthy  than  New  South  Wales,  both  in 
the  Old  World  and  the  New." 

In  speaking  of  the  causes,  he  says:  "First,  the  earlier  population 
came  under  exceptional  circumstances — the  relations  of  crime  and  in- 
sanity are  very  intimate;  second,  the  ups  and  downs  of  early  colonial 
life,  the  influence  of  the  gold  diggings;  third,  the  lonely  life  of  the 
shepherd,  alternating  with  long  periods  of  debauchery;  fourth,  the 
abuse  of  ardent  sj^irits  in  a  warm  climate.  On  the  other  hand,  the  ab- 
sence of  grinding  poverty  and  the  salubrity  of  the  climate  tend  to  dimin- 
ish mental  disease." 

With  the  exception  of  the  convict  element  in  the  population  of  New 
South  Wales,  what  is  here  said  is  as  applicable  to  this  State  as  to  that 
colony. 

CAUSES    TENDING    TO    THIS    RESULT. 

These  causes  have  acted  as  powerfully  here  as  there,  and  Dr.  Manning 
might  have  added,  with  equal  propriety,  other  causes  that  act  quite  as 
potently  in  producing  this  malady  as  any  of  the  foregoing: 

First — The  total  change  in  the  habits  of  life. 

Second — The  absence  of  those  salutary  restraints  imposed  by  the  pres- 
ence of  well  organized  society. 

Third— T\\Q  separation  from  family  and  friends;  and,  above  all,  the 
strange  and  mysterious  influence  of  being  away  from  home  in  a  foreign 
land.  In  many  cases  with  no  mother  nor  sister  near  to  watch  over  and 
care  for  them  in  sickness;  no  wife  by  to  soothe  their  sorrows  with  cheer- 
fulness and  smiles,  and  by  tender  sympathy  drive  away  the  gloom  of 
despondency,  and  with  heroic  fortitude  encourage  them  after  failure  in 
some  cherished  project  again  to  buckle  on  the  armor  of  determination 
and  fight  for  success. 

All  of  these  causes,  and  doubtless  many  others,  must  be  opemting, 
with  various  degrees  of  activity  and  power,  on  the  foreign  born  citizens 
of  our  country  and  State — in  what  degree  in  the  different  States  and  Ter- 
ritories will  be  seen  in  the  table  next  hereafter;   Avhile  the  succeeding 


199 

table  has  been  prepared  to  show  the  relation  of  California  in  this  respect 
to  the  whole  country;  the  next  to  show  the  rate  of  increase  of  the  popu- 
lation, the  insane,  and  the  idiotic,  from  the  birth  of  the  State  to  ei.i»:hteen 
hundred  and  seventy;  the  next  to  show  the  percentages  of  tliese  ele- 
ments; the  next  table  shows  that  more  than  sixty -two  per  cent  of  the 
population  of  California  in  eighteen  hundred  and  seventy  Avere  born  in 
the  United  States,  while  less  than  thirty-six  per  cent  of  the  insane  were 
supplied  from  their  number — being  a  proportion  of  one  to  eight  hundred 
and  fifty-eight.  The  proportion  of  citizens  of  foreign  birth  is  thirty- 
seven' and  forty-five  one  hundredths  per  cent,  and  the  proportion  of  the 
insane  from  their  numbers  sixty-four  and  thirty-nine  one  hundredths 
per  cent,  or  one' to  two  hundred  and  eighty-four;  thus  showing  that  per- 
sons of  foreign  birth  are  three  times  as  susceptible  to  the  invasions  of 
insanity  as  those  Avho  were  born  in  the  United  States.  By  reference  to 
the  table  next  hereafter,  it  will  be  seen  that  the  proportion  of  the  foreign 
element  is  much  greater  in  California  than  in  any  other  State,  and  there- 
fore we  need  not  be  surprised  at  the  greater  increase  of  insanity  in  our 
midst.  And  as  the  same  causes,  oj^erating  under  similar  circumstances, 
will  always  produce  the  same  results,  we  may  reasonably  expect  the 
growth  of  lunacy  to  continue  till  these  conditions  are  changed. 


200 


.^      S 


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Proportion  of  Foreign 
Insane  to  Illative 
Insane 


Proportion  of  Foreign 
Insane  to  Foreign 
Population 

Proportion  of  ^Xative 
Insane  to  Xative 
Population 


Proportion  of  total  In- 
sane to  total  Popu- 
lation   


Foreign  Inss 


Native  Ins 


Total  Insane. 


Foreign  Population. 


Native  Population... 


I     Total  Population. 


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26 


O   IJ  ®  1.'-'  L""  1>»  Li»- 


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202 

RESULTS    OF    TREATMENT. 

Haviug  considered  the  subject  of  the  treatment  of  insanity  and  the 
rapid  growth  of  hosj^itais,  and  having  shown  how  rapidly  insanity  itself 
has  apparently,  if  not  actually,  increased  in  all  countries  during  the  last 
forty  years,  let  us  consider  the  far  more  important  subject  of  the  results 
of  treatment  in  the  various  countries  under  consideration.  The  first  of 
the  accompanying  tables  shows  the  number  resident  at  the  beginning  of 
the  year,  the  admissions,  numbers  treated,  recoveries,  and  deaths,  with 
proportions  of  recoveries  and  deaths  in  the  asylums  of  the  several  coun- 
tries from  which  returns  could  be  obtained  and  of  the  latest  dates  that 
could  be  procured: 

AVhile  the  last  table  sets  forth  similar  facts  for  one  hundred  and  thirty- 
six  of  the  one  hundred  and  forty-nine  asylums  visited,  the  results  as 
exhibited  in  this  table  are  for  the  year  eighteen  hundred  and  sixty-nine 
in  the  United  States  and  Canada,  and  for  eighteen  hundred  and  seventy 
in  the  other  countries.  Though  these  tables  differ  in  results  in  some 
respects,  they  agree  in  showing  that  the  largest  proportion  of  recover- 
ies to  numbers  treated  and  the  smallest  percentage  of  deaths  to  numbers 
admitted  are  in  the  United  States.  This,  of  course,- may  be  the  result  of 
accident,  as  it  requires  a  series  of  years  and  a  knowledge  of  all  the  facts 
to  enable  us  to  draw  positive  conclusions  in  matters  of  this  character. 
The  average  per  cent  of  cures  to  admissions  in  all  the  asylums  visited 
was  thirty-four,  while  in  the  United  Stated  it  was  thirty-seven.  The 
average  of  deaths  to  admissions  in  all  was  twenty-seven,  and  in  the 
United  States  only  seventeen.  This  we  believe  to  be  owing  to  the  fact 
that  the  patients  in  our  asylums  are  allowed  a  more  liberal  diet  than  in 
any  other  country,  and  that  the  debilitating  effects  of  the  continued  bath 
so  commonly  used  on  the  continent  are  entirely  ignored  in  this  country. 
There  may  be  other  causes  operating  to  produce  this  remarkable  differ- 
ence (sixty-three  per  cent)  in  the  mortuary  lists  of  all  other  countries,  as 
compared  with  our  own,  though  the  two  above  cited  seem  fully  adequate 
to  the  result. 

As  already  seen  in  the  foregoing  table,  of  all  the  patients  admitted 
during  the  3^ear,  in  the  one  hundred  and  thirty-nine  asylums  under  con- 
sideration, thirty-four  per  cent  w^ere  cured,  and  twenty-seven  per  cent 
died,  leaving  thirty-nine  per  cent,  most  of  whom  must  be  added  to  the 
chronic  list,  and  thus  swell  the  number  of  the  insane.  This  is  doubtless 
as  favorable  a  showing  as  could  have  been  made  had  all  the  institutions 
in  the  world  been  comprised  in  the  list,  as  many  of  these  are  considered 
among  the  best  asylums  ever  established,  and  are  conducted  by  as  able 
and  learned  men  as  have  lived  in  any  age.  AVell  may  we  inquire,  then, 
'•  if  this  is  a  necessary  part  of  our  natural  condition  or  our  civilization, 
to  make  this  annual  sacrifice  of  regiments  of  men  and  women  on  the 
altar  of  mental  destruction,  can  the  causes  producing  these  effects  in  any 
way  be  avoided,  and  some  of  this  sacrifice  be  prevented?"  We  will  permit 
others  of  more  experience  and  wiser  heads  to  answer  the  question. 

CURAKILITY    OP    THE   INSANE. 

"  In  a  2:)erfect  state  of  things,  where  the  best  appliances  whi  ch  the 
science  and  skill  of  the  age  have  provided  for  healing  are  oftered  to  tho 
lunatics,  in  as  early  a  stage  of  their  malady-  as  they  are  to  tho^e  whe 
are  attacked  with  fever  or  dysentery,  probably  eighty,   and  possibly 


203 


ninety,  per  cent  would  be  restored,  and  only  twenty,  or  perlnips  ten,  per 
cent  would  be  left  among  the  constant  insane  population.'' — Dr.  Jarvls. 

liot'erring  to  this  assertion,  it  is  staletl,  in  reference  to  the  Utica  Asy- 
lum, that  ""its  influence  lias  been  such  that  every  acute  case  happening 
in  the  county  is  at  once  j)laced  under  hospital  treatment.  The  result  is 
that  o\\\y  five  per  cent  of  those  treated  in  the  early  stage  of  the  disease 
remain  as  incurables;  thus  more  than  verifying  the  assertion  of  Doctor 
Jar  vis.* 

Doctor  Tuke  says:  "It  is  of  great  practical  importance  to  remember 
that  the  chances  of  cure  are  very  much  greater  in  recent  than  in  chronic 
cases.  This  is  clearly  shown  by  the  experience  of  the  Ketreat,  in  tlie 
following  table :f 

Proportion  of  Recover tes  on  per  cent  of  Admissions.. 


York  Ketreat— 179()  to  1857. 


DURATION   OF   DISORDER  WUEX   ADMITTED. 


Male,      i     Female. 


First  attack  and  within  three  months 72.97 

First  attack,  above  three  and  within  twelve 

months I  43.07 

Not  first  attack,  and  within  twelve  months!  59.44 


73.23 

44.2 

67.01 


Averacro. 


73.10 

43.6G 

G3.77 


First  or  not  first  attack, 
twelve  months 

and   more  than 

- 

13.29 

• 
22.59 

18.20 

Totals 

49.54 

49.50 

49.44 

EFFECTS    OF    EARLY    TREATMENT. 


The  Superintendent  of  the  Southern  Ohio  Lunatic  Asylum,  in  his 
report  for  eighteen  hundred  and -sixty-nine,  shows  hoAv  the  expectation 
of  recovery  diminishes  almost  in  exact  proportion  to  the  length  of  time 
the  disease  has  existed,  thus: 


DURATION. 


Adi 


missions. 

Recoveries. 

Per  Cent. 

530 

363 

68.49 

219 

141 

63.01 

164 

88 

53.65 

98 

53 

54.08 

177 

83 

46.32 

239 

103 

43.09 

163 

47 

28.83 

191 

33 

17.32 

One  month 

Two  months 

Three  months.... 

Four  months 

Six  months 

Twelvemonths.. 

Two  years 

Over  two  years 


»  See  Journal  of  Insanity,  Vol.  XXVII,  p.  332. 
t  See  Bucknill  and  Tuke  on  Insanity,  p.  2G1. 


204 

The  above  table  is  for  the  period  of  years  from  eighteen  hundred  and 
fiftj'-five  to  eighteen  hundred  and  sixty-nine  inclusive. 

This  is  a  universally  admitted  fact  which  has  been  in-oved  by  the  expe- 
rience of  hospitals  almost  without  exception,  and  is  by  far  the  most 
powerful  agent  that  can  be  employed  in  preventing  the  increase  of 
insanity  m  our  midst— at  least  in  jpreventing  its  accumulation  in  our 
asylums.  But  as  the  experience  of  individual  asylums  may  not  be  con- 
sidered a  fair  test  of  so  important  a  matter,  we  add  the  following  table 
showing  the  results  in  many  asylums  in  several  countries  for  a  series  of 
years : 


505 


>ij 

h3 

5i 

< 

P2 

?:j 

W 

^ 

^ 

Deatlis  on  Nunxber 
Treated 


Deaths 


Recoveries. 


Numbers  Resident. 


Admissions 


Numbers  Resident.. 


i-IOf-ICOO^K^GO—l'-t 

lo  ci  Ci  o  t-  o  o  >o  Tt<  c:> 

CO  1^  -;t<  1^  O  lO  lO  CO 


1^  lo  c-i  00  1^ 

I O  O  CO  CO  CO 
CO  C5  X  O  CO 


01  O  O  CO 

O  CO  r-l  ,-1 


i.o  cq  CO  CO  o  oi  CO  o  1^ 


0  0-1  LO  (M  O  Ci  iH  -tI  CO  <M 

01  CO  rH  CO  GO  O  lO  O  (>l  CO 

<M^ni_o_uo^i-^C5^co  crs  Tti  CO 


CI  CO  t^  rH  ^  r-H  ^  O  1^  O 
O  rH  rH  (M  CO  O  -^  W  CO  C5 
1^  05  CO  "-J,!^  I— I  -tl  r-l  O  O 


O  O  O  O  O  W  i-O  00  1^  -^ 
1-  1^  X^  1^  CD  CO  O  CO  CO  CO 
(XOCQOOOGOGOOOcyDGOCO 


^    : 

C3      . 


O    rt    «^    '" 


2  2 


-f' 

!> 

o 

C^H 

!^ 

'  ' 

CO 

be 

=s     S 


H  M-e 


206 


Average  weekly  cost  for  ;     g    i  2^  9^  o  g  g  g  i^  i^  =c  g  oc      ; 
Pauper  Patients ^   •  ^^  ^^  ^^^  ^  !Ii  Z^  c^  r-i  rn  ,h  t^     ' 


Death?  on  dum- 
ber Treated... 


i^  ^  w  ci^  ^  X  X  or  O  i-t  X  Ci 


Deaths    on  Ad- 
missions  


Cares  on  dum- 
ber Treated... 


X  c^i  -1 1^  1^  i^  c;  r:  X  *-c  i^ 


"           Cures  on  Admis- 
I  sions 


-f  irt  ur;  ir:  c-:  'M  T-^  cq  CO  CO  Qo  1^  o 
„  ,  c:r:xc^7'^">c-ti:o^i-n^ia5o 

Xo.  Treated ^1^^  ^-:,^.'^.H'-v^.R,«  £^'-^S. 


Xo.  Died. 


Xo.  Cured 


Xo.  Admitted. 


Xo.  Resident., 


Ci^5<i:c:C!MOOcC'-iCirHLt 
o      (M  cq  c^  oi  c<i  i-i  LO  'O  s=co  f-i 


o  Lt  X  ic  t^  -•:  :r  1^  t^  -f  ^1  'M  r: 
'i;  ct  L-:  ^  ic  1^  1^  o  1-  -^  r:  r:  c^i 

c-i      -^  r:  -^  X  :m  i-^  ic  i^  5F=t\i  >-i 


1^  X  ci  o  t^  X  1-':^  L-:  c-T  ci  c<j  c;  lo 

o.-('-HC5cocoCi(r:OL':;!r;c<iT*< 

OiO  30^ C^"^^^  O  CO  Cn|  •*  O  •>! 


Xo.  Asylums  visited  from 
which  Reports  were  ob-  '     ?: ""  ^^  "~^  ^^  ^ 
tained 


o  n  "  L-  -7  X 


Cft 


O    tl 


O  I^  --i'  O  to  -*  '>C  1^  r-l  1^  CO  C5  ^ 
CO  1^  CO  CO'  O  CM  -H  Ci  -J-  -^  X  -^  -1 
O    C5  O  Ol  CO  O  CM  1^  Ol  s=l-  CO 


^11 


o 


o 


p^ 


;i  :  :  :  :  :  rt 
I  :^  :  •  •  :  :^ 

!   S'^  ci  ci  s  o  5 "^   V. 


207 


^  ^ 

o*  ;i 

-.>  -t"^ 

o    <^ 

&s 

^^ 

<w  Cfi 

-<  '^^ 

^^ 

« <;. 

^-^^ 

s  "^^^ 

§"&> 

^^s 

o 

C^iS^ 

*;:r^  '^ 

'TS   ^ 

si  '~~^ 

'^S  "^^ 

^-^ 

s:>    ?i 

•  -    ^ 

^§ 

02 

H 

^         ^(S 

<1 

«        ^    ^ 

H 

hJ          .^    » 

rr> 

M         "^  V 

<          S    ^ 

ft 

H         -^ 

N 

o   ^ 

H 
f— 1 

^•s 

^ 

S  '^ 

P 

S^"" 

P^^ 

5^ 

5S 

5i> 

<V)     CO 

•--.< 

.oKh 

i^ii 

f^    :^ 

Si 

cs 

^    ^ 

s 

1^ 

^'^- 

r< 

» 

S? 

^  '^ 

^ 

■^rq  >^ 


g 

l< 

^ 

•^ 

^ 

S'Ei^ 

^ 

c:- 

s 

1 

GQ 

■ 

Proportion  of  the  Foi-- 
eign    Insane   to    the 
Native  Insane 

1  to  1,261   1  to  496    1  to  233 

i 

Proportion  of  the  For- 
eign   Insane   to    the 
Foreign  Population- 

Proportion  of  the  Na- 
tive   Insane    to    the 
Native  Population... 

Proportion  of  the  Total 
Insane  to  the  Total 
Population 

T— 1 

CO 

o 

l^'n7'Oir''n   Tii^?inp    

T— T 
r-t 

Native  Insane 

t 

CO 

T— < 

co'^ 

CM 

Total  Insane 

(M 

CO 

co^ 

CO 

i 

Foreign  Population 

CO 
lO 
CO 

la 

Native  Population 

00 
GO 

^. 

(M 

OO 

i     Total   Population 

38,555,983 

o 

.& 

'o 

rH 
O 

o 

.2 

o 

0^ 


208 

Table, 

Showing  the  Population  and  N^imbers  of  Insane  and  Idiots  in  1850.  1860, 
and  1870,  icith  the  proportion  per  one  thousand  of  Insane  and  Idiots  to 
Pop\dati<m,  and  the.  Annual  Bate  of  Increase  of  Insane,  Idiots,  and  total 
Population. 

CALIFORNIA. 


Katio  per  1,000  of—       ;    Annual  Increase  of- 


YEAR. 

^ 

— 

ji 

c'  -' 

c"5^ 

-     r*   ~                           — 

? 

/■- 

i 

r- 

3j 

fc 

^  ^ 

:    H^Ei            ? 

? 

St 

:    ^ 

:    l^           : 

1850      \ 

92,597 

o 

■    T 

9 

.02     1 

.07 

1 

.09      K.ifi 
1.31       jl'^-1'^ 

72.1 

19  62 

1860     i 

379,994 

456  ' 

42 

498 

1.20 

.11 

1870     1 

i 

560,^47 

1,146 

87 

1,233 

2.04 

.15 

2.20     1       3.95 

1 

9.6 

7.55 

Table 


Showing  Total  Population  with  Native  and  Foreign  Pojndation,  and  projjor 
tion  of  the  Native  and  of  the  Foreign  to  the  Total  Population. 


YEAR. 


Total 
Population. 


1850 
1860 

1S70 


«  92,597 
379,994 
500.247 


Native 
Population. 


70,340 
2.33,466 
350,416 


I  Proportion  of  Proportion  of 

Foreign        i       Native  to  Foreign  to 

Population.  •  \  Total  Popula-  Total  Popula- 
'           tion.  tion. 


*  In  eighteen  hundred  and  fifty  the  nationalit}-  of  four  hundred  and  fifty-five  persons 
was  unknown. 

Table. 

Showing  Total  Xumber  of  Insane,  icith  Native  and  Foreign  Insane,  and  pro- 
jjortion  of  the  Native  and  of  the  Foreign  to  the  Total  Insane,  and  of  the  For- 
eign to  the  Native  Insane. 


YEAR.         It              :=;          \  ^^g- 
?              1              i            : &^ 

Proportion  of  Na- 
tive   Insane    to 
Native    Popula- 
tion  

Proportion  of  For- 
eign to  Total  In- 
sane  

Proportion  of  For- 
(iign    Insane    to 
Foreign  Popula- 
tion   

1850                   2                   2      100       1  to  35,170 

1860     ■           4.56      .-. 

1870     I       1,146-   1          408     .          738     ■      35.60      , .     64.39           1  to       858 

1                      i                      !                      !                      '                      ' 

1  to  284 

209 


y 


Table, 

SlioiDiiuj  the  total  number  of  Idiotic,  icith  Native  and  Foreign  Idiotic,  and 
proportion  of  the  Native  and  of  the  Foreign  to  the  total  Idiotic,  and  of  the 
Foreign  to  the  Native  Idiotic. 


H 

^ 

^ 

^ 

^ 

^ 

^ 

^ 

o 

£ 

i 

iM 

m. 

■m 

2'!^ 

0-3 

^ 

crq' 

m2 

so 

S-o 

o2 

OurA-     > 

^r4- 

=      .-f-r^ 

r+r4. 

a 

M 

h-( 

ion 
ioti 

2§" 

"^  §' 

i°§ 

hj3 

TEAKS. 

f" 

O 

: 

5" 

Bio 

0-. 

igs. 

|2> 

: 

:    » 

i    ^ 

9*^ 

i  gfei 

IS^ 

1— • 

:    o 

:    o 

P 

:    o 

:   o 
:  crq" 

•   2.' 

tive 
Pop 

ft 

:    H 

:    '^ 

:    ^ 

:   c  M 

•      HH 

i    ? 

i  ^ 

:    o 

i  ?r 

:    't^ 

1850 

87 

6 

1 

85.71 

14.28 

16.66 

1  to  11,723 

I860. 

1870 

70 

17 

80.45 

19.54 

24.28 

Ito    5,005 

1  to  12,343 

CALIFORNIA   NO    EXCEPTION. 

This  shows  that  Califorjiia  is  not  an  exception  to  the  general  rule;  for 
while  the  insane  have  increased  within  her  borders  more  raj^idly  than 
in  any  other  country  during  the  same  period  of  time,  it  must  not  be 
overlooked  that  her  citizens  have  not  only  been  exposed  to  a  greater 
number  of  causes  by  which  this  malady  is  developed,  but  that  she  is 
perhaps  the  only  State  in  the  Union,  if  not  the  only  Government  in  the 
world,  that  has  never  refused  admission  to  a  single  person  who  has 
sought  to  enter  her  asylum,  notwithstanding  it  is  a  well  known  fact  that 
among  those  received  there  have  been  and  still  are  many  citizens 
of  other  countries,  who  have  not  claimed  California  as  a  home,  but  who 
have  come  here  hoping  to  better  their  fortunes  and  enrich  themselves  at 
her  expense,  and  then  return  to  their  own  homes  and  country;  but  failing 
to  realize  their  dreams  of  wealth,  give  way  to  despondency,  break  do^u 
in  health,  or  enter  upon  a  course  of  reckless  dissipation  that  leads  them 
to  insanity  and  to  our  as^dum,  either  to  be  cured  by  our  treatment  or 
maintained  through  life  at  the  expense  of  the  State. 

How  far  this  evil  may  be  remedied  or  ameliorated  by  judicious  legis- 
lation, is  a  problem  that  we  are  not  ])repared  to  solve;  but  surely  it 
would  seem  that  some  preference  should  be  given,  some  difference  made, 
between  this  class  and  our  own  citizens;  but  if  we  must  keep  them,  it 
does  seem  that  the  comity  of  nations  should  prompt  them  to  reimburse 
us  for  the  expenditure  made.  The  doctrine  has  been  proclaimed,  and 
repeatedly  confirmed  by  the  superintendents  of  American  institutions 
for  the  insane,  and  by  those  who  have  paid  any  attention  to  the  subject 
the  world  over,  "that  it  is  the  duty  of  every  State  to  provide  for  its 
own  insane."  In  this  sentiment  we  heartily  concur,  and  earnestly  urge 
its  adoption  by  our  noble  State,  without  equivocatioAi  or  reservation. 
But  the  other  is  a  very  different  question;  nor  do  we  now  remember  any 
instance  of  a  declaration  to  the  effect  that  it  is  the  duty  of  one  Govern- 

27 


210 

ment  to  defray  the  charity  expense  of  another.  In  other  countries,  and 
even  in  different  divisions  of  the  same  country,  persons  of  this  class  are 
often  transferred  to  the  communities  to  which  they  belong.  The  ques^ 
tion  is  at  least  worthy  of  consideration. 

SHOULD  OTHER  STATES  SEND  THEIR  INSANE  TO  CALIFORNIA  ? 

In  this  connection  another  question,  though  intrinsically  different,  is 
nevertheless  analagous  to  some  extent,  and  deserves  notice,  not  so  much 
on  account  of  its  present  importance  as  its  future  results.  It  is  to  inquire 
how  far  a  sister  State  may  be  justified  in  establishing  her  institutions 
within  the  borders  of  another?  Is  it  just  or  proper  for  one  State  to  send 
all  of  her  insane  in  the  limits  of  another,  even  though  she  may  pay  the 
expense  of  care  and  maintenance?  It  is  fair  to  presume  that  when  they 
are  considered  sufficiently  recovered  to  require  no  further  medical  treat- 
ment  that  they  will  not  be  returned  to  the  State  from  which  they  come, 
but  turned  loose  upon  the  community  where  the  asylum  is  located. 
Should  a  speedy  relapse  follow  their  discharge,  they  would  of  course  be 
sent  back  to  the  asylum  in  which  they  had  been  treated;  but  when  a  few 
months  have  elapsed  they  would  be  committed  under  our  laws,  and  sent 
to  our  asylum,  and  thus  become  an  additional  charge  upon  the  State. 
We  all  know  that  a  large  majority  of  the  insane  are  from  that  class  who 
are  not  able  to  pay,  and  that  persons  who  have  been  afflicted  with  this 
malady  are  more  liable  to  be  attacked  than  an  equal  number  who  have 
not  been  thus  affected.  The  burden  of  all  these  will  inevitably  fall  upon 
us.  For  these  reasons  it  would  seem  j^roper  for  the  State  to  express  an 
opinion  on  this  subject. 

WILL   THE   CHILDREN     OF     FOREIGNERS   BE   AS     LIABLE   TO   INSANITY   AS    THEIR 

PARENTS? 

We  do  not  know  and  have  no  means  of  ascertaining  how  far  this 
liability  extends  to  the  children  Avho  are  born  of  parents  of  foreign  birth, 
but  venture  the  opinion  that  it  will  be  only  in  a  small  degree.  If  this 
hypothesis  be  correct,  it  must  necessarily  follow  that  the  proportion  of 
insane  will  diminish  very  nearly  in  proportion  to  the  increase  of  the 
native  over  the  foreign  element  in  the  mass  of  the  people.  This  will  of 
course  become  more  and  more  rapid  with  each  successive  generation; 
for  while  the  one  is  supplied  with  emigration  from  the  other  States  and 
all  the  children  born  in  the  State,  regardless  of  the  nativity  of  their 
parents,  the  other  must  be  increased  by  immigration  alone. 

PHYSICAL   AND   MORAL    CAUSES   PRODUCING   INSANITY. 

Having  considered  some,  perhaps  most,  of  the  prominent  causes  of 
insanity,  r,o  far  as  it  is  affected  in  a  social  or  political  point  of  view,  it 
may  be  expected  that  we  will  enter  upon  the  consideration  of  the  more 
prominent  of  the  physical  and  moral  causes  leading  to  this  malady;  but 
we  scarcely  consider  it  necessary  to  do  more  than  allude  to  some  of 
them.  We  have  already  given  a  table  showing  a  few  of  the  more  prom- 
inent assigned  causes  in  all  the  countries  visited  during  the  prosecution 
of  our  mission,  but  without  special  comment.  By  referring  to  that  table 
it  will  be  seen  that  they  very  generally  agree  with  those  operating  in 
our  State,  but  differing  in  degree  and  intensity  in  some  countries.  Thus, 
hereditary  predisposition  and  intemperance  are  assigned  as  prominent. 


211 

causes  in  all  countries,  and  in  Prussia  and  the  German  States  they  arc 
the  only  causes  of  prominence.  In  Italy  we  find  pellagra  (disease  of  the 
skin  jieculiar  to  that  country)  added  to  the  other  two,  while  in  most 
other  countries  we  find  added  to  the  list  ill  health,  pecuniary  and  domes- 
tic troubles,  and  spermatorrhoea,  including-  self-abuse,  etc.  In  our  State, 
we  see  by  the  report  of  Dr.  Shurtleff,  just  published,  that  masturbation 
still  holds  its  place  at  the  head  of  the  list  of  assigned  causes,  though  wo 
agree  with  him  that  it  is  high  time  for  ''  Committing  Boards  "  to  be  more 
careful  in  their  conclusions  with  regard  to  this  particular  cause.  Many 
patients  who  have  been  received  at  the  asylum  with  this  charge  of  self- 
pollution  resting  upon  them,  have,  after  weeks  or  months  of  watchful- 
ness, been  proved  to  be  entirely  free  from  such  evil  practices.  That  it 
is  a  cause  in  some  cases  we  have  every  reason  to  believe;  and  further 
than  this,  when  it  is  the  cause  its  victims  rarely  recover;  they  seem  to 
be  doomed  from  the  very  beginning.  There  are  Other  cases  in  which  it 
is  merely  a  symptom  of  a  diseased  brain,  or  some  of  its  appendages — an 
efi'ect,  not  a  cause.  These  cases  are  more  hopeful  when  treated  in  time. 
Indeed,  many  men  of  prominence  with  whom  we  have  met  on  the  conti- 
nent, in  Great  Britain,  and  in  the  United  States,  believe  that  it  is  almost 
universally  the  effect  of  insanity,  and  not  its  cause, 

INTEMPERANCE  A  LEADING  CAUSE  OF  INSANITY. 

AYith  regard  to  intemperance  the  case  is  altogether  different.  It 
seems  to  be  the  bane  of  all  countries,  and  claims  its  victims  in  every 
civilized  nation  and  under  every  form  of  government.  It  is  the  common 
enemy  of  mankind,  the  destroyer  of  domestic  happiness,  the  copartner 
of  every  crime,  from  petit  larceny  to  murder.  It  is  the  father  of  pov- 
erty, the  creator  of  debauchery,  and  the  principal  working  tool  of  the 
Devil.  No  man  is  bold  enough  to  defend  it,  and  yet  it  is  tolerated  by 
all  classes  of  society.  It  finds  its  way  alike  to  the  house  of  the  rich  and 
the  home  of  the  poor.  It  is  a  boon  companion  at  the  festive  board  of 
the  aristocrat,  and  the  poorly  provided  table  of  the  cottager.  It  has 
caused  more  heartaches,  produced  more  tears,  engendered  more  sorrows, 
starved  more  babies,  and  led  to  more  insanity  than  any  other  agent  in 
existence — if  not  more  than  all  others  combined.  We  are  strongly 
inclined  to  the  opinion  that  directly  or  remotely  it  is  more  potent  in  pro- 
ducing these  results  than  all  other  causes.  It  is  the  sin  of  civilization 
that  it  has  found  out  manifold  ways  of  extracting  alcohol  from  natural 
substances,  so  that  it  is  offered  in  tempting  forms  and  accessible  abundance 
to  the  weak  and  incautious,  who  would  not  instinctively  seek  it,  as  well 
as  those  whose  appetites  demand  it.  If,  then,  civilization  is  responsible 
for  the  introduction  of  this  destructive  element  among  mankind,  it  is 
certainly  its  duty  and  it  should  be  compelled  to  provide  for  its  victims. 
How  to  arrest  its  progress,  if,  indeed,  it  be  possible,  we  must  leave  to  the 
Aviser  heads  of  the  legislator  and  the  statesman;  and  he  who  can  solve 
the  problem  will  be  the  wisest  of  men,  and  a  greater  benefactor  to  his 
fellow  men  than  has  ever  yet  appeared  among  them. 

We  have  thus  briefly  considered  this  last,  as  it  is  the  most  prolific, 
among  the  causes  that  have  given  us  so  large  a  number  of  persons  de- 
prived of  their  reason;  who  crowd  the  wards  of  our  asylum  till  there  is 
scarce  sleeping  room  or  breathing  space  for  the  numbers  they  contain, 
to  say  nothing  o^  the  accumulations  that  must  take  place  ere  additional 
accommodations  can  be  provided  for  their  reception.     The  question  must 


212 

be  determined  as  to  what  is  best  to  be  done  in  performing  our  duty  and 
relieving  their  distress. 

DUTY    OF    THE    STATE   RELATIVE    TO    ASYLUMS. 

The  State  must  elect  whether  it  will  build  other  hospitals,  and  thereby 
pay  the  cost  of  cure,  or  support  all  those  for  life  who  become  incurable 
from  our  failure  to  provide  sufficient  and  suitable  accommodation  for 
their  early  treatment — whether  to  make  the  effort  to  regain  a  productive 
citizen,  or  support  a  non-jDroducer  for  seventeen  years.  We  must  either 
provide  hosj^itals  for  the  reception  of  every  citizen  who  may  become 
insane  within  our  borders  and  under  our  jurisdiction,  or  surrender  this 
noble  charity  to  degeneracy  and  decay.  As  already  stated,  this  has 
been  done.  Xo  other  State,  so  far  as  our  knowledge  extends,  has  done 
so  much;  a  fact  that  is  doubtless  a  source  of  gratification  and  pride  to 
every  man  who  claims  California  as  a  home.  We  regret,  however,  that 
candor  compels  us  to  say  that  some  of  the  wards  of  the  male  department 
of  our  asylum  are  wretched  in  the  extreme,  and  would  be  disgraceful 
if  not  taken  in  connection  with  the  fact,  that  the  number  of  applicants 
have  been  so  far  beyond  expectation  as  to  render  it  next  to  impossible  to 
provide  accommodations  for  them  all.  Eeceived  they  have  been,  but 
during  the  last  two  years  at  the  discomfort  of  many  who  were  thus 
compelled  to  give  up  a  portion  of  the  space,  already  too  small,  that  had 
been  allotted  to  them.  Doctor  Shurtlefi*  in  his  rejDort  just  published, 
has  truly  said  "the  rooms  are  not  only  full,  but  crowded.''  In  addition  to 
this,  two  hundred  and  twenty-seven  patients  are  sleeping  on  beds  nightly 
prepared  for  them  in  the  halls.  The  number  in  excess  of  the  accommo- 
dations has  grown  to  j^i'oportions  too  vast  to  admit  of  being  properly 
provided  for  by  the  erection  of  cheap  detached  wards.  The  institution, 
in  point  of  numbers,  is  already  double  the  size  of  the  average  of  similar 
^institutions  in  the  other  States.  With  the  completion  of  the  new  build- 
ing, therefore,  all  further  expansion  should  be  discontinued.  This  done, 
aside  from  the  cost  of  support,  every  other  effort  and  exjDenditure  in 
behalf  of  the  asylum  at  Stockton  should  be  directed  to  repairs,  the  con- 
struction of  inclosures,  and  the  improvement  of  the  grounds,  etc. 

"  If  this  view  be  concurred  in,  the  only  alternative  left  is  for  the  State 
to  make  further  provision  elsewhere.  The  character,  extent,  and  loca- 
tion of  such  provisions  are  questions  upon  which  every  possible  light 
should  be  shed.  In  character,  nothing  less  than  a  first  class  hospital, 
with  all  the  modern  improvements  and  appliances  for  the  curative  treat- 
ment of  such  as  may  be  benefited  thereby,  and  for  the  proper  care  of  all 
classes  of  the  insane,  will  meet  the  general  approval  of  the  most  experi- 
enced;" and,  we  may  add,  the  expectations  of  the  people  of  the  State. 
Doctor  Shurtlefi'  continues:  "If  additional  provision  for  the  care  of  the 
insane  be  made  at  some  other  place  than  Stockton,  the  question  of  locality 
is  one  of  no  less  importance  than  those  of  character  and  extent.  Topo- 
graphical and  climatic  fitness  are  matters  of  such  primary  importance 
that  they  will  not  be  likely  to  be  overlooked.  Convenience  to  the  great- 
est number  who  will  be  likely  to  need  its  benefits  is  a  very  important 
consideration,  in  many  resjoects,  in  the  location  of  a  hospital  for  the 
insane.  Officers'  fees  and  travelling  expenses,  which  dej^end  on  the 
distance,  and  are  a  public  charge  generally,  the  difficulty  and  even  danger 
in  conveying  the  insane,  and  the  visits  of  friends,  are  all  matters  which 
should  be  considered  and  have  their  influence  in  arriving  at  conclusions. 
In  this  connection  it  should  be  borne  in  mind  that  of  the  five  hundred 


213 

and  twenty-three  patients  admitted  during  the  last  year,  about  three 
hundred  came  from  the  counties  bordering  on  the  Bay  of  San  Francisco, 
and  that  two  hundred  and  twenty-two — more  than  two  fifths  of  the 
whole — came  from  the  City  of  San  Francisco  alone.  This  proportion  is 
no  exception  to  those  of  several  years  past." 

These  suggestions,  emanating  from  Doctor  ShurtleflP,  a  close  and  accu- 
rate observer,  with  a  correct  judgment,  and  a  larger  experience  than  any 
man  on  this  coast,  should  not  be  lightly  passed  over  nor  disregarded. 
They  are  the  results  of  serious  reflection  on  an  important  subject  with 
which  he  has  been  intimately  identified  for  years,  and  his  conclusions 
can  be  maintained  with  manifold  reasons  of  the  strongest  character. 
With  a  single  exception,  that  of  size  of  hospital,  they  entirely  accord 
with  the  views  expressed  to  your  Excellency  soon  after  the  completion 
of  our  visit  to  nearly  one  hundred  and  fifty  asylums,  wherein  we  had 
noted  with  especial  interest,  among  other  things,  and  observed  with 
more  than  ordinary  scrutiny  and  careful  consideration,  the  effects  of 
overcrowded  wards  and  courtyards,  the  location  and  sites  of  asylums, 
their  nearness  to  and  distance  from  some  city  or  important  town,  the 
character  of  scenery,  quantity  and  quality  of  land,  the  sources  of 
water  supply,  the.  facilities  of  communication,  the  convenience  and  cheap- 
ness with  which  fuel,  supplies  of  all  kinds,  and  building  material  could 
be  obtained,  as  well  as  all  other  matters  in  any  way  connected  with  the 
construction,  ventilation,  warming,  organization,  etc.,  of  hospitals  for 
the  insane,  and  which  are  treated  more  or  less  at  length  under,  their 
proper  heads;  and  above  all,  to  the  importance  of  locating  these  institu- 
tions in  the  midst  of  those  most  likely  to  require  the  benefits  they 
confer. 

In  many  of  the  States  inadequate  j)rovisions  are  made  for  treating 
the  insane,  followed  by  the  most  disastrous  results.  Large  numbers 
who  desired  to  gain  admittance  have  been  turned  away  and  told,  "  not  in 
w^ords,  but  in  acts  that  are  more  powerful  than  words,"  to  wait  till  some- 
body gets  well  or  dies,  and  then  after  the  disease  has  fastened  itself  upon 
your  brain  so  firmly  that  it  cannot  be  removed,  when  all  hope  of  recovery 
has  passed,  you  may  come  in,  and  in  your  turn  keep  some  other  equally 
unfortunate  person  out  till  he,  too,  becomes  hopelessly  incurable,  lost  to 
himself,  lost  to  his  family,  and  lost  to  the  State — yet  a  burden  to  the 
public  treasury  so  long  as  he  shall  live.  No  one  who  is  at  all  familiar 
with  the  nature  of  this  malady  wiU  deny  these  facts;  every  person  who 
has  written  or  sjDoken  upon  the  subject  during  this  generation  has 
asserted  them  till  they  have  ceased  to  be  denied. 

Last  year,  as  we  learned  from  personal  information  obtained  from 
some  of  the  superintendents  of  asylums,  and  from  the  published  reports 
of  others,  the  following  facts  existed: 


At  Staunton,  Yirginia,  of  two  hundred  and  eight  applicants,  only 

fifty-nine  were  admitted;  rejected 

In  the  ^Michigan  Asylum,  rejected 

In  the  Asylum  in  North  Carolina,  rejected 


149 
155 
150 


Dr.  Everts,  of  the  Indiana  Asylum,  informed  us  that  not  more  than 
one  third  could  be  accommodated  in  that  State,  and  as  three  hundred 
and  fourteen  were  admitted,  it  follows  that  six  hundred  and  twenty- 


214 

eight  must  have  been  rejected.  Yes,  strange  as  it  may  appear,  this 
young  and  vigorous  State,  the  sixth  in  point  of  population  in  the  Ameri- 
can Union,  and,  as  we  are  informed,  the  only  one  free  from  the  burden 
of  debt;  with  low  taxation  and  abundant  resources;  with  one  mil- 
lion six  hundred  and  eighty  thousand  six  hundred  and  thirty-seven 
inhabitants,  has  turned  away  from  her  asylum  two  thirds  of  her  own 
unfortunate  children  who  have  sought  relief  at  her  hands.  Who  could 
have  believed  it  possible  in  this  enlightened  age  that  any  community  of 
American  citizens  could  be  guilty  of  such  cruel  practices  and  such  par- 
simonious conduct  as  this?  And  yet  the  fact  is  as  stated.  Doctor  Hills, 
of  West  Yirginia,  rej^orts  from  sixty  to  seventy-five  in  the  jails  of  that 
young  State;  and  the  State  Board  of  Charities  report  thirteen  hundred 
and  twenty-six  in  the  poorhouses  of  Xew  York.  The  States  of  Maine. 
Iowa,  Illinois,  and  others  are  no  better  oif.  Unlike  Indiana,  however, 
most  of  these  States  are  making  noble  efforts  to  remedy  this  evil,  because 
they  recognize  the  obligation  and  the  duty,  and  feel  no  disposition  to 
shirk  the  responsibility  nor  to  avoid  the  expense.  Indeed,  we  would 
like  to  know  what  right  a  State  has  to  make  such  unjust  distinctions 
between  its  citizens;  to  say  to  one,  ''Come  and  be  healed,"  and  to 
another,  "Go  hence;  you  shall  not  partake  of  the  benefits  you  have 
helped  to  create."'  To  one,  "You  shall  come  in,  be  fed,  clothed,  housed, 
and  nursed;  our  physician  shall  minister  to  your  diseased  frame  and 
release  your  troubled  mind  from  its  agonizing  thraldom.*'  To  the  other, 
"  We  have  no  house  to  shelter  your  head  from  the. pitiless  storms;  no 
food  to  appease  your  hunger;  no  raiment  to  cover  your  nakedness  or  add 
to  your  comforts;  no  nurses  to  watch  over  you  in  sickness  and  minister 
to  your  necessities.  For  you  there  is  no  sympathy;  you  must  take  care 
of  yourself,  pay  your  own  expenses,  and  provide  for  your  necessities  as 
best  you  can.  For  you  'there  is  no  balm  in  Gilead,  there  is  no  physician 
there.'  " 

What  is  the  result  of  this  policy?  Nine  tenths  of  these  people  have 
no  means  of  consequence.  AVhile  in  the  possession  of  health,  and  en- 
dowed with  that  greatest  of  earthly  blessings,  their  reason,  they  were 
able  to  support  themselves,  and,  it  may  be,  lay  up  a  little  something  for 
their  families;  and  if  this  had  not  already  been  exhausted  by  ill  health 
or  other  cause  that  has  led  them  gradually  to  insanity,  this  calamity  has 
deprived  them  of  the  chief  part  if  not  all  of  their  capital — the  ability  to 
work.  The  family  who  have  hitherto  depended  upon  these  resources 
must  now  look  to  other  means  and  other  persons  for  supj^ort.  They 
cannot  afford  to  send  this  afliicted  member  of  the  family  to  a  private 
asylum — it  may  be  in  another  and  distant  State — nor  can  they  aftbrd  to 
keep  him  at  home  and  have  him  properly  treated.  They  are  out  of  rela- 
tion with  social  and  domestic  life,  and  should  go  away.  It  is  often  the 
case  the  very  presence  of  family  and  home  is  a  source  of  annoyance  and 
vexation  that  they  cannot  endure. 

THE   INSANE   CANNOT   BE   KEPT   AND   CURED   AT   HOME. 

They  are  a  great  burden  to  the  family,  and  disturb  its  quiet  and  its 
peace;  and  if  retained,  as  is  not  unfrequently  the  case,  drag  all  down  to 
poverty  and  misery  with  themselves.  Besides,  they  require  to  be  man- 
aged with  fitting  wisdom,  that  few  can  give,  however  willingly  and 
cheerfully  disposed,  and  with  that  amount  of  patience  and  forbearance 
not  often  found  outside  of  asylum  wails.  Indeed,  many  cannot  be  man- 
aged at  home  on  account  of  a  disposition  to  wander,  to  be  violent,  or 


215 

destructive.     Some  cannot  be  persuaded  to  submit  to  the  needful  reme- 
dies for  their  proper  treatment,  even  when  this  could  be  obtained. 

PHYSICIANS    NOT    GENERALLY   INFORMED   ON    THIS   SUBJECT. 

Unfortunately,  but  few  of  the  medical  men  in  general  practice  in  our 
country  or  any  other  have  made  themselves  familiar  with  this  myste- 
rious disease  and  its  proper  treatment.  The  reason  of  this  is  obvious — 
it  is  a  branch  not  taught  in  any  of  our  medical  schools  as  a  part  of  the 
course.  It  is  not  a  part  of  the  curriculum  in  the  colleges  of  any  coun- 
try; hence,  proficiency  in  this  branch  is  not  a  "  sine  qua  non  "  for  a  medi- 
cal diploma.  They  are  sometimes  called  upon  to  pronounce  as  to  the 
sanity  of  some  unfortunate  person  and  to  decide  whether  or  not  he  is  a 
proper  subject  to  be  sent  to  an  insane  asylum.  In  the  majority  of  cases 
they  have  never  seen  the  patient  before  and  never  see  him  afterwards. 
Again :  when  some  criminal  puts  in  the  plea  of  insanity  to  save  his  neck 
or  his  reputation,  the  physician  is  called  upon  to  testify  in  the  case,  and, 
as  often  happens,  is  mortified  to  find  that  the  lawyer  knows  more  about 
the  subject  than  himself.  The  one  has  "read  himself  up"  for  the  occa- 
sion, and  can  ask  more  questions  than  an  author  of  medical  jurispru- 
dence could  answer  satisfactorily  to  the  Judge  or  jury;  while  the  doctor, 
perhaps,  has  given  the  subject  but  little  thought  or  attention.  We  trust 
this  condition  of  things  will  soon  be  changed,  as  more  attention  is  being 
paid  to  the  subject  both  in  this  country  and  Europe. 

PSYCHOLOGY   RECOMMENDED   TO   BE   TAUGHT   IN   THE   MEDICAL   SCHOOLS. 

The  Superintendents  of  many  of  the  asylums  in  Italy,  Austria,  Ger- 
many, France,  and  England  are  giving  courses  of  lectures  on  the  science 
of  psychology,  and  the  Association  of  Medical  Superintendents  of  Ameri- 
can Institutions  for  the  Insane  has  strongly  recommended  its  adoption 
as  a  branch  in  the  medical  schools  of  this  country.  When  this  sugges- 
tion has  been  carried  out  a  wonderful  advance  will  have  been  made  m 
the  right  direction  and  many  persons  saved  from  the  calamity  of  chronic 
insanity  by  having  their  diseases  early  detected  and  properly  treated. 
But  let  us  return  to  our  patient  who  has  not  been  able  to  procure  proper 
treatment  in  an  asylum  in  time  to  obtain  even  a  chance  of  recovery  while 
relief  was  possible,  and  we  find  him  at  last  admitted  to  a  place  made 
vacant  by  the  death  of  some  patient  who  has  paid  his  last  debt  to  the 
"grim  tyrant,"  or  the  recovery  of  some  other  who,  more  fortunate  than 
himself,  was  received  in  proper  time.  But,  alas!  it  is  too  late  for  him. 
His  case  has  become  chronic,  perhaps  incurable,  and  he  is  doomed  to  eke 
out  a  wretched  existence— a  burden  to  himself  and  to  the  State  during 
the  remainder  of  his  days. 

EFFECTS    OF   LIBERAL   AND   ECONOMICAL   PLAN    OF   CARE   OR   TREATMENT. 

The  following  extracts  from  the  report  of  the  Worcester,  Massachu- 
setts, Hospital  for  eighteen  hundred  and  sixty-two,  will  show  the  effect 
of  the  two  policies  on  the  use  of  hospitals,  and  cure  of  patients: 

"  The  natural  effect  of  the  liberal  and  the  economical  policies  of  offer- 
ing the  hospitals  to  the  use  of  the  people,  is  manifest  in  the  different 
ratios  of  the  patients  sent  in  the  early  and  in  the  later  stages  of  their 
malady  to  the  hospitals  in  Massachusetts  and  Ohio. 


216 

"  In  Ohio  seventy-three  and  one  seventh  per  cent,  and  in  Massachu- 
setts sixly-four  and  one  eighth  per  cent  of  the  patients  in  their  State 
hospitals  were  sent  in  the  first  year  after  they  were  attacked. 

"As  a  necessary  consequence,  those  States  which  sent  the  largest  pro- 
jDortion  in  the  early  and  curable  stage  received  back  the  largest  propor- 
tion in  health  and  power  of  usefulness,  and  had  the  smallest  proportion 
left  in  confirmed  immovable  lunacy  to  be  supported  for  life  by  their 
estates  or  the  public  treasuries. 

'-In  the  three  jDublic  hosj^itals  of  Ohio,  fifty-four  and  fifty-nine  one 
hundredths  per  cent  of  all  that  were  sent  to  them  were  restored,  and 
forty -three  and  forty  one  hundredths  per  cent  remained  insane  for  life. 
In  Massachusetts,  forty-four  and  five  one  hundredths  per  cent  were 
restored,  and  fifty-five  and  ninty-five  one  hundredths  per  cent  remained 
a  life  burden  on  the  people. 

'•  It  must  be  remembered  in  this  connection  that  the  reports  of  admis- 
sion into  the  hospitals  of  Massachusetts  include  both  the  foreign  or 
State  j)aupers  who  are  admitted  free,  and  the  American  paying  j^atients 
who  are  charged  more  than  the  cost  for  their  support.  If  distinction 
were  made  in  the  reports,  and  it  were  shown -how  many  of  each  of  those 
two  classes  were  sent  in  the  several  stages  of  their  disorder,  it  would, 
without  doubt,  be  found  that  a  much  larger  proportion  than  thirty-five 
and  two  one  hundredths  per  cent  of  the  native  patients  were  kept  out  of 
the  hospital  until  their  disease  become  more  difficult  and  even  impossible 
to  be  removed. 

''It  is  not  necessary  to  go  abroad  to  find  the  connection  between  the 
terms  of  admission  and  support,  and  tlie  readiness  with  which  people 
avail  themselves  of  hospital  privilege  for  the  ctire  or  custody  of  their 
insane  friends.  We  have  proof  of  this  in  our  own  daily  experience. 
Our  Irish  patients  go  free  and  stay  without  cost,  and  they  are  sent  early 
and  have  the  best  opportunities  of  restoration.  The  Americans  go  at 
their  own  cost,  and  pay  all  and  more  than  all  of  the  expense  of  their 
support,  and  consequently  a  large  proportion  are  kept  away,  some  for 
months  and  years,  as  long  as  their  friends  can  endure  or  take  care  of 
them,  and  many  for  life,  because  their  friends  lack  courage  or  money  to 
take  due  advantage  of  the  means  of  restoration  so  largely  provided  in 
the  State.  In  eighteen  hundred  and  fifty-nine,  ninty-seven  and  five 
tenths  per  cent  of  all  the  foreign  and  only  fifty-eight  per  cent  of 
the  native  lunatics  then  living  in  the  State  had  been  sent  to  some 
hospital. 

"  The  proportion  of  patients  restored  out  of  all  admitted  to  the  hos- 
pitals, is  twenty-three  per  cent  greater  in  Ohio  than  in  Massachussetts. 
^ow,  no  one  will  suppose  that  the  hospitals  of  Ohio  are  managed  with 
more  skill  than  those  of  this  State.  But  the  difterence  in  the  result  of 
their  labors  is  due  to  the  diff'erence  in  the  proportion  of  patients  sent  i]i 
the  curable  stages  of  their  disorder. 

"Looking  U2:)on  this  matter  merely  as  a  question  of  political  economy, 
in  its  bearing  upon  the  remote  as  well  as  present  means  and  prosperity 
of  the  State,  it  is  jjlain  that  there  are  important  advantages  on  the  side 
of  the  free  and  open  system  of  managing  these  public  charitable  institu- 
tions. They  send  back  to  society  a  larger  proportion  of  workers,  pro- 
ducers, self-su2:>porters,  and  contributors  to  the  public  treasury,  and  leave 
a  smaller  proportion  of  the  useless  and  burdensome  class.  Inasmuch  as 
they  have  a  better  or  more  available  material  to  work  upon,  they  pro- 
duce a  more  successful  result,  and  convert  a  larger  ^^roportion  of  costly 
men  and  women  into  profitable  members  of  the  body  politic.     The  Wor- 


217 

cester  and  Taunton  Hospitals  have  received  eight  thousand  four  hundred 
and  ninety,  and  restored  three  thousand  seven  hundred  and  forty  to 
health.  If  these  could  have  beeii  sent  at  as  early  a  stage  of  their  dis- 
ease, and  as  large  a  j^roportion  restored  as  in  Ohio,  then  twenty-three 
per  cent,  or  eight  hundred  and  sixty  would  have  been  added  to  the  use- 
ful and  self-sustaining  citizens  sent  back  to  the  Avorld,  and  as  many 
taken  from  the  class  that  has  been  or  must  be  supported  and  cared  for 
through  life. 

"  It  must  be  further  considered  that  it  costs  no  more  to  administer 
these  institutions  on  the  free  principles  of  Ohio  than  on  the  economical 
principles  of  Massachusetts.  Both  there  and  here  provisions,  groceries, 
clothing,  labor,  and  salaries  would  be  the  same  under  either  system. 
The  only  difference  is  in  the  way  in  which  the  cost  is  assessed  upon  the 
peoi^le.  Here  it  is  imposed  upon  those  who  receive  the  immediate  per- 
sonal advantage,  many  of  whom  are  the  least  able  to  bear  it,  and  always 
at  a  period  when  they  are  the  weakest,  and  any  burden  is  distressing. 
In  the  other  case,  this  cost  of  rescuing  the  peoi)le  from  permanent 
insanity,  like  the  cost  of  schools,  roads.  Government,  justice,  and  police, 
is  assessed  upon  the  whole  community,  in  the  proportion  that  each  one 
is  able  to  pay;  and  in  both  cases  it  comes  out  of  the  aggregate  propert}^ 
and  income  of  the  Commonwealth." 


Any  attempt  to  save  money  by  failing  to  i^rovide  for  the  insane  is 
indeed  poor  economy,  and  worse  philanthropy.  Let  us,  therefore,  adhere 
firmly  to  the  policy  we  have  so  wisely  inaugurated,  and  which  has  placed 
us  in  the  front  ranks  among  the  States  of  the  Union  and  the  nations  of 
the  world,  and  build  asylums  for  all  of  our  people  wdio  may  be  so  unfor- 
tunate as  to  require  their  use  and  need  their  healing  influence.  In  this 
connection,  we  deem  it  of  some  imj^ortance  to  introduce  the  following- 
extract  from  a  Message  from  Mr.  Seward  (when  Governor  of  New  York) 
to  the  Legislature: 

"  I  cheerfully  exj^ress  my  approbation  of  the  undertaking.  Nations 
are  seldom  impoverished  by  their  charities.  The  number  of  the  insane  in 
this  State  is  not  exaggerated,  and  I  am  not  prepared  to  say  that  any 
erection  less  extensive  would  afford  the  space,  light,  tranquility,  and 
cheerfulness  indispensable  to  this  interesting  department  of  the  healing- 
art.  Among  all  His  blessings,  none  call  so  loudly  for  gratitude  to  God 
as  the  preservation  of  our  reason.  Of  all  the  inequalities  in  the  social 
condition,  there  is  none  so  affecting  as  its  privation.  He  sees  fit  to  cast 
upon  our  benevolent  care  those  whom  He  visits  with  that  fearful  afflic- 
tion; it  would  be  alike  unfeeling  and  ungrateful  to  withhold  it.  Let  then  this 
noble  charity  be  carried  forward,  with  what  measure  of  munificence  it 
remains  with  you  to  determine." 

Like  sentiments  have  been  2^1'oclainied  by  the  intelligent  executive 
officers  of  most  of  the  States  of  the  Union,  our  own  included,  but  unfor- 
tunately in  too  many  instances  legislators  are  frightened,  or  driven  from 
their  duty  by  the  "  criticisms  of  that  class  of  public  benefactors  who 
make  capital  from  their  sympathy  with  our  overtaxed  j^eople,"  and  no 
appropriation  is  made.  Fortunately,  at  this  time,  however,  no  such 
objection  can  be  urged.  The  Democratic  party  has  seen  the  necessity  of 
additional  accommodations  for  the  insane,  and  it  only  remains  for  the 

28 


218 

Eepublican  party,  ever  the  friend  of  progress,  to  carry  forward  the  sug- 
gestion and  complete  the  work.  It  is  a  noble  charity,  and  no  excuses 
should  be  needed  to  justify  any  appropriation  that  may  be  required; 
under  judicious  expenditure,  to  meet  the  necessities  of  the  case;  nor 
should  the  subject  of  politics  weigh  a  feather  in  the  balance  of  any 
man's  mind  in  his  considerations  or  his  actions  upon  the  subject.  It  did 
not  do  so  two  years  ago,  when  the  investigation  was  ordered  to  be  made 
of  which  this  report  is  the  result,  and  there  is  no  reason  why  it  should 
do  so  now.  Our  labors  have  been  performed  with  the  hope  that  suffer- 
ing humanity  would  be  the  gainer  by  the  results,  and  if  this  shall  prove 
to  be  the  case  we  will  have  reaped  the  most  earnest  desire  of  our  heart, 
and  a  reward  beyond  price.  Hence  we  have  ventured  the  suggestion 
that  the  one  party  and  the  other  will  be  equally  responsible  for  any 
appropriations  that  may  be  made  and  equally  entitled  to  the  honors  of 
so  beneficent  a  deed. 

"We  can  lose  nothing  by  our  charities  in  this  direction.''  Let  us  not 
only  provide  ample  accommodations  for  all  of  our  insane,  but  let  us  so 
locate  our  asylums  that  they  will  be  easily  accessible  to  the  greatest 
number  of  those  who  will  probably  require  their  use,  and  then  with  an 
enlightened  public  opinion  all  will  be  encouraged  to  seek  the  benefits  of 
early  treatment  and  speedy  restoration.  Comparatively  a  few  only  will 
be  left  as  permanent  charges  to  the  State.  A  much  greater  number  will 
be  restored  to  usefulness  and  labor.  The  State  will  be  the  gainer  by 
the  operation,  and  humanity  will  smile  at  the  triumph  of  wise  legislation 
and  judicious  treatment  over  the  most  appalling  disease  with  which  the 
human  race  has  ever  been  afflicted. 


CHAPTEE    XY. 


INSANE   ASYLUMS — ECONOMY     OP    PROVIDING    AMPLE    CURATIVE    ACCOMMODA- 
TIONS. 

Before  entering  upon  the  discussion  of  the  plan  of  building  best 
adapted  to  the  care  and  treatment  of  the  insane,  we  desire  to  call  the 
attention  of  the  business  man,  the  financier,  and  the  taxpayer,  as  well  as 
the  legislator,  to  the  economy  of  restoration  and  the  amount  saved  the 
State  by  the  cures  already  eflected  in  our  asylum. 

A  similar  showing  was  made  by  Doctor  Jarvis  a  few  years  since  to 
the  State  of  Massachusetts,  and  to  him  we  are  indebted  for  the  idea  and 
most  of  the  facts  set  forth  in  this  article.  We  have  applied  them  to 
California,  and  in  making  the  argument  must  necessarily  touch  upon 
some  matters  already  considered.  It  is  a  proposition  universally  admit- 
ted that  it  is  the  first  interest  of  every  State  to  preserve  itself,  to  develop 
its  own  strength,  and  to  sustain  it  to  the  fullest  degree.  The  strength 
and  wealth  of  the  State  are  the  aggregate  of  the  wealth  and  power  of 
the  individuals  who  compose  it.  If  a  member  of  the  community  is 
strong,  his  strength  increases  the  power  of  the  State.  If  he  be  a  pro- 
ducer and  create  riches,  this  adds  so  much  to  the  common  wealth. 

If,  on  the  contrary,  he  become  sick  or  weak  and  lose  his  power  of  pro* 
duction,  his  loss  of  personal  power  takes  so  much  from  the  general 
power.     His  failure  to  add  to  his  own  estate  is  so  much  loss  to  the  gen- 

/ 


219 

era!  prosperity.  If,  more  than  this,  he  loses  power  to  provide  for  his 
own  wants,  his  support  becomes  a  charge  upon  property  that  he  or  others 
have  created,  or  are  at  the  time  creating.  If  his  own  means  o*v  those 
of  his  fiimily  are  insufftcient  for  this  purpose,  then  the  public  treasury 
must  and  does  assume  the  burden. 

Whether  this  support  of  a  dependent  citizen  comes  from  his  own  or 
others'  estate,  or  the  general  treasury,  it  inevitably  comes  from  the 
property  of  the  commonwealth,  either  that  which  has  already  been  paid 
in  form  of  taxes  to  the  Government,  or  that  which,  in  the  hands  of  indi- 
viduals, is  the  basis  of  taxation.  In  either  case  the  body  politic  is  the 
loser  to  the  extent  of  the  cost  of  supporting  the  disabled  person. 

In  all  cases  this  cost  is  first  chargeable  to  the  estate  of  the  one  sup- 
ported. If  that  be  wanting,  then  his  natural  friends  should  pay  it;  and 
if  they  fail,  the  expense  falls  on  the  town  or  State.  This  last  resort  is 
sure,  for  the  town  or  State  is  the  responsible  indorser  of  every  sick, 
disabled,  or  insane  person  within  its  borders,  to  restore  him  to  health  or 
support  him  through  life. 

There  is  in  every  community,  especially  in  such  as  have  had  a  genera- 
tion of  existence,  a  large  body  of  the  insane  who  are  a  constant  burden 
on  its  resources.  In  Massachusetts,  in  eighteen  hundred  and  fifty-five, 
there  was  one  insane  person  in  every  four  hundred  and  twenty-seven 
living.  In  other  States  and  counties  there  are  estimated  to  be  from  one 
in  four  or  five  hundred  to  one  in  a  thousand.  A  part  of  these  are  the 
recent  cases,  that  have  a  hope  of  restoration;  a  larger  part  consists  of 
old  and  iucurable  cases  that  have  been  submitted  to  the  healing  pro- 
cesses without  avail,  or  have  been  neglected  until  the  day  of  relief  was 
past. 

The  burden  of  sui^porting  these  is  constant,  unavoidable,  and  very 
great.  It  is  the  first  claim  of  humanity,  as  well  as  the  duty  and  interest 
of  the  body  politic,  to  keep  the  numbers  of  these  as  small  as  possible,  by 
healing  all  that  can  be  healed  in  the  curable  stage  of  their  disorder,  and 
allowing  none  but  those  whose  disease  is  primarily  incurable  to  fall  into 
chronic  and  permanent  lunacy. 

Insanity,  although  it  suspends  the  power  of  production,  self  care,  and 
self  support,  is  not  in  itself  very  dangerous  to  life.  A  man  becoming 
insane  at  twenty,  if  not  restored,  has  a  prospect  of  living,  on  an  aver- 
age, twenty-one  years  in  lunacy;  but  if  restored  his  prospect  is  for 
thirty -nine  years  in  health.  The  average  of  life  for  a  permanent  lunatic 
is  twenty  years,  and  for  a  sane  man  thirty-two  years,  from  their  thirty- 
first  year;  and  these  prospects  are  respectively  seventeen  and  twenty- 
six  years  from  their  forty-first  year.  Persons  taken  with  lunacy  at  these 
ages  have,  then,  the  doubtful  prospect  of  living  twenty-one,  twenty,  or 
seventeen  years,  more  or  less,  according  to  the  age  when  attacked,  in 
dependence,  a  burden  on  their  own  or  the  public  estate,  if  not  restored; 
or  of  being  cured  and  of  living  thirty-nine,  thirty-two,  or  twenty-six 
years,  more  or  less,  in  health,  ability  to  take  care  of  themselves,  and 
acid  to  the  strength  and  wealth  of  the  community. 

Insanity  is  one  of  the  most  removable  of  grave  diseases,  if  the  proper 
measures  are  used  in  its  early  stages,  as  they  are  in  cases  of  fever,  dys- 
entery, etc.  The  experience  of  hospitals  shows  that  from  seventy  to 
ninety  per  cent  may  be  thus  restored  to  health.  The  average  time 
required  for  restoration  in  hospitals  varies  from  five  and  a  half  to  seven, 
and  even  eight  months.  But  the  average  of  the  whole,  especially  those 
taken  early,  does  not  exceed  six  months. 

The  average  cost  of  supporting  patients  in  the  California  asylum  for 


220 

the  four  last  years  was  thirteen  dollars  and  eighty-five  cents  ($13  85)  a 
month.  This  is  eighty-three  dollars  send  ten  cents  (383  10)  for  six 
months,  and  one  hundred  and  sixty-six  dollars  and  twenty  cents 
(8166  20)  for  a  year.  The  actual  cost  of  restoration  necessarily  includes 
the  whole  expense  of  the  experiment.  It  is  impossible  to  determine  in 
advance  who  may  be  restored — who  must  remain  uninfluenced  by  reme- 
dial measures.  These  must  then  be  used  for  the  whole;  some  may  be 
restored  in  a  few  weeks,  others  in  all  periods  from  this  to  two  years  and 
more — averaging  six  months  to  all;  but  none  must  be  given  ujd  as  incur- 
able until  they  have  had  at  least  two  years  trial  of  the  means  of  cure. 

The  cure  of  the  seventy-five  per  cent  thus  necessarily  involves  the 
necessity  of  two  years  board  and  care  of  the  other  twenty-five  per  cent. 
This  must  also  be  included  in  the  list  of  cases  and  assessed  upon  the 
seventy-five  who  are  restored. 


The  cost  of  seventy-five  cured,  for  six  months  is 

The  cost  of  twenty-five  not  cured,  for  two  years  each  is. 

Total 


§623  25 
831  00 


$1,454  25 


Assessing  this  equally  upon  them  makes  the  average  cost  of  curing 
the  insane  in  California  to  be  one  hundred  and  ninety-three  dollars  and 
eighty-six  cents. 

It  must  be  remembered  that  this  cost  of  supporting  seventy-five  for 
six  months  and  twenty-five  for  two  years  in  a  hosj^ital — fourteen  hun- 
dred and  fifty -four  dollars — for  the  restoration  of  the  seventy-five  is  not 
so  much  additional  expense  thrown  upon  the  people.  These  hundred 
persons  were  already  insane,  helpless,  powerless,  unable  to  support  them- 
selves. They  were  already  thrown  upon  the  community  and  its  indi- 
vidual members,  who  were  responsible  for  their  maintenance  whether 
they  were  sent  to  the  hospital  or  not;  whether  any  attempt  was  or  was 
not  made  to  restore  them.  The  Commonwealth  collectively,  or  its 
estates  separately,  must  pay  the  cost  of  their  board,  care,  and  guar- 
dianship. 

It  is  questionable  whether  out  of  a  hospital,  a  private  house,  or  other 
abodes,  at  home  or  with  strangers,  these  patients  could  obtain  food  for 
less  than  it  cost  the  asylum  for  them — three  dollars  and  twenty  cents 
(83  20)  a  week.  If  not,  then  the  curative  measures  in  the  asylum 
caused  no  additional  expense  to  the  State  or  its  people,  except  the  cost 
of  the  establishment  itself  The  interest  on  the  capital;  the  wear  and 
depreciation  of  the  buildings;  the  cost  of  repairs;  the  insurance,  and 
the  taxes  which  would  other■s^'ise  have  been  paid  to  the  public  treasury 
on  this  amount  of  property,  are  j)roperly  chargeable  to  the  cost  of  curing 
the  insane,  and  nothing  more. 

Here,  on  the  contrary,  must  be  weighed  the  gain  to  the  community 
from  the  restoration  of  the  insane  to  health.  The  annual  earnings  of  a 
man  over  and  above  the  expense  of  his  living  may  be  considered  as  an 
annuity,  or  so  much  annually  contributed  to  the  commonwealth.  Accord- 
ing to  the  best  Euroj^ean  calculations  of  these  values — the  earnings  and 
expenditures — the  present  worth  of  the  excess  of  the  former  over  the 
latter,  for  an  unskilled  laborer  at  twenty-five,  is  twelve  hundred  and 
eight  dollars  (81,208).     That  is,  such  a  laborer  at  that  age  is  worth  so 


221 

much  to  the  body  politic.  This  is  the  English,  and  very  nearly  the 
German  valuation.  In  this  country  wages  are  higher  and  earnings 
more,  and  of  course  the  annuity  and  its  valuation  are  greater.  This, 
too,  is  the  estimated  value  of  an  unskilled  laborer,  who  earns  the  lowest 
wages.  The  value  of  the  skilled  mechanic,  the  merchant,  the  profes- 
sional man,  whose  earnings  are  larger,  must  be  very  much  greater.  It 
is  at  least  safe,  then,  to  assume  the  European  calculation  of  twelve  hun- 
dred and  eight  dollars  as  the  average  worth  of  men  of  all  conditions 
and  occuj^ations  in  California  who  may  become  insane  at  the  age  of 
twenty-five. 

This  is  lost  by  his  lifelong  insanity.  Add  to  this  the  cost  of  his  sup- 
2)ort,  at  least  as  great  as  that  charged  in  the  asylum — thirteen  dollars 
and  eighty-five  cents  a  month,  one  hundred  and  sixty-six  dollars  and 
eighty-five  cents  a  year,  for  an  average  of  twenty-one  years: 


Making  for  each  uncured  patient  a  total  expenditure  for  sup- 
port   

Add  the  loss  of  the  value  as  a  producer 

Showing  a  total  loss  of. 


83,490  83 
1,208  00 


^4,698 


So  much  is  gained  by  restoring  an  insane  laborer  twenty-five  years 
old.  It  would  have  been  less  if  he  had  been  older,  with  a  prospect  of 
fewer  years  before  him;  it  would  have  been  more  if  he  were  a  mechanic 
or  man  of  business,  with  power  to  earn  more  if  in  health.  The  cost, 
only  one  hundred  and  ninety -three  dollars,  is  neutralized  b}^  the  consid- 
eration that  it  would  have  been  as  great  for  his  support  if  no  attempt 
had  been  made  to  restore  him. 

During  the  twenty  years  of  the  operation  of  the  California  Asylum, 
five  thousand  six  hundred  and  eighty-one  lunatics  were  admitted.  Of 
these  two  thousand  seven  hundred  and  nine,  or  forty-seven  and  sixty- 
eight  one  hundredths  per  cent,  were  restored.  This  relieved  the  State 
and  people  of  the  burden  of  supporting  these  through  life  in  their  dis- 
ease. Taking  the  numbers  in  their  several  ages,  their  average  life,  if  not 
cured,  would  have  been  twelve  years  each;  or  the  whole  sum  of  their 
insane  lives  would  have  been  thirty-two  thousand  five  hundred  and  eight 
years,  and  their  life  support,  at  one  hundred  and  sixty-six  dollars  a  year, 
would  have  been  four  million  four  hundred  and  ninety-seven  thousand 
and  four  dollars,  which  was  saved  for  the  State.  Their  average  valua- 
tion, considered  merely  as  laborers  earning  the  lowest  wages,  when 
restored  to  health  and  productive  power,  was  eleven  hundred  and  two 
dollars  eaph;  making  a  total  of  two  million  seven  hundred  and  sixty- 
three  thousand  and  eighteen  dollars  which  was  regained.  Both  of  these 
make  a  total  of  seven  million  two  hundred  and  sixty  thousand  and 
twenty-two  dollars  which  has  been  gained  to  the  State  and  people  by 
the  restoration  of  these  twenty-seven  hundred  and  nine  insane  joersons 
in  the  asylum  at  Stockton. 

This  calculation  presuj^poses  that  all  these  were  original  cases,  and ' 
then  no  readmission;  but  although  the  record  does  not  state  it,  there 
must  have  been  here,  as  elsewhere,  periodical  cases,  some  being  more 
than  once  and  some  several  times  attacked,  sent  to  the  hospital,  and 
there  cured.     These  of  course  had  shorter  periods  of  health  than  this 


average,  and  their  years  should  be  deducted.     This  would  reduce  the 
sum,  but  would  still  leave  a  very  great  amount  lost  by  uncured  insanity. 


CHAPTEE  XYI. 


INSANE  ASYLUMS— PLAN  BEST  ADAPTED  TO  CAPvE  AND  TREATMENT 

OP  THE  INSANE. 

General  Observations— Cottage  System — Parm  Asj'lums — Close  Asylums — Pavilion  Plan. 
GENERAL    OBSERVATIONS. 

From  the  foregoing  considerations,  then,  there  will  be  no  question  that 
the  State  has  a  very  great  interest  in  the  cure  of  the  insane.  Yet  there 
may  be  a  question  as  to  the  best  manner  of  effecting  it.  ^Ye  have 
already  shown  why  they  cannot  be  properl}'  cared  for,  treated,  and 
cured  in  private  houses,  at  least  in  California;  and  also  why  we  prefer 
moderately  small  to  very  large  asylums.  As  it  is  not  probable,  however, 
that  an  appropriation  could  be  obtained  for  two  asylums  with  a  capacity 
for  two  hundred  or  two  hundred  and  fifty  patients  each,  in  accordance 
with  our  views,  we  trust  that  none  for  more  than  four  hundred  patients 
will  ever  be  built.  In  saying  this,  we  have  not  forgotten  the  suggestion 
made,  that  the  north  Aving  of  the  Female  Asylum  at  Stockton  should  be 
finished.  It  must  be  remembered  that  the  removal  of  two  or  three  most 
uncomforable,  unsightly,  and  objectionable  wards  was  at  the  same  time 
deemed  a  most  desirable  end  to  be  accomplished,  so  soon  as  a  new 
asylum  could  be  erected;  and  furthermore,  that  having  already  con- 
structed a  centre  building  (always  the  most  expensive  part  of  any 
asylum),  together  with  kitchen,  chapel,  engine  house,  boilers  for  heating, 
and  otlier  necessary  comcomitants  for  an  asylum  to  accommodate  a 
given  number,  this  improvement  can  be  made  at  less  cost  than  at  any 
other  place,  to  say  nothing  of  the  pressing  demands  for  the  room  it  would 
more  speedily  supply  than  in  any  other  way.  We  have  an  asylum  at 
Stockton  which  in  some  respects  is  not  what  it  should  be;  and  we  desire 
to  see  these  evils  remedied.  The  improvements  suggested  would  accom- 
plish this  object;  nor  do  we  consider  this  improvement  at  all  incon- 
sistent with  the  views  expressed  Vvdth  regard  to  the  size  of  asylums; 
this  would  only  be  the  completion  of  a  hospital  already  begun,  and  is 
simply  a  matter  of  necessity;  whereas  a  different  system  may  and  should 
prevail  in  the  construction  of  all  asylums  to  be  hereafter  built. 

THE    COTTAGE    SYSTEM. 

We  have  already  had  occasion  to  speak  of  the  different  kinds  of  as}'- 
lums  in  vogue  in  several  countries,  in  our  sketch  of  the  report  of  Doctor 
Manning.  AVhat  he  had  to  say  of  the  cottage  system,  as  practiced  at 
the  Colony  of  Gheel,  and  the  modification  of  that  system,  as  adopted  to 
some  extent  in  Scotland,  entirely  agrees  with  the  conclusions  at  which 
we  ourselves  had  arrived:  that  however  well  adapted  the  system  may 
be  for  old  and  thickly  settled  communities,  it  is  '•  altogether  inapplicable 
to  a  new  or  sparsely  settled  country."'  Much  has  been  written  upon 
this  system  by  some  of  the  foremost  men  of  the  Continent,  of  Great 


223 

Britain,  and  the  United  States;  some  advocating  its  adoption  in  their 
respective  countries,  while  others  condemn  it  in  no  mild  terms  as  being- 
unworthy  even  of  respectful  consideration.  Esquirol,  Guislain,  Morcau, 
Parigot,  Bulckens,  DeMundy,  Duval,  Roller,  Droste,  Halliday,  Ste- 
vens^ Brown,  Sibbald,  Earle,  Gait,  Tyler,  Bemis,  and  a  host  of  others, 
have  visited  the  famous  old  Colony  at  Gheel,  and  given  the  results  of 
their  exj^eriences  and  observations  to  the  world.  Manning  came  next, 
and  we  followed  in  the  wake  of  all,  and  had  set  forth  our  views  at  some 
length,  not  only  with  regard  to  Gheel,  but  also  the  Scotch  system,  of 
keeping  a  certain  class  of  lunatics  in  private  dwellings.  But  as  we  have 
no  Gheel  in  America,  and  no  such  population  as  that  among  whom 
lunatics  are  kept  in  Scotland,  it  is  unnecessary  to  print  them.  Nine 
tenths  of  the  patients  kept  at  Gheel  in  Belgium,  and  at  Kennoway  in 
Scotland,  we  believe,  are  better  satisfied  than  they  would  be  in  hospitals; 
but  it  would  be  impossible  to  induce  our  people  to  take  charge  of  such 
patients  for  the  cost  of  keeping  them  in  our  asylums.  Hence,  it  would 
be  useless  to  discuss  the  cottage  system  with  a  view  to  its  adoption  in 
our  country. 

We  refer  the  curious,  and  those  who  may  desire  to  learn  more  of  the 
history  of  Gheel  and  the  cottage  system,  to  the  interesting  essays  of  Dr. 
John  Sibbald,  of  Scotland,  who  has  written  the  most  satisfactory  account 
of  them  with  which  we  have  met,  and  which  may  be  found  in  the  Jour- 
nal of  Mental  Science  for  April,  1861;  to  that  of  Dr.  Henry  Stevens,  pub- 
lished in  the  same  journal  for  April,  1858;  and  to  that  of  Dr.  Merrick 
Bemis,  to  be  found  in  the  Worcester  Hospital  Report  for  1869 — all  of 
which,  with  numerous  other  articles  upon  this  and  kindred  subjects,  are 
among  the  books  which  now  adorn  the  shelves  of  the  medical  depart- 
ment of  our  State  Library.  Indeed,  with  Winslow's  Psychological  Jour- 
7ial,  the  Journal  of  Mental  Science,  and  the  American  Journal  of  Insanity  in 
our  library,  to  say  nothing  of  the  large  number  of  other  works  that 
keep  these  company,  it  would  be  difficult,  if  not  impossible,  to  touch  upon 
any  subject  relating  to  insanity  that  cannot  be  found  ably  and  thoroughly 
discussed  in  some  of  them.  Had  a  tithe  of  the  information  which  they 
contain  been  known  by  our  people,  or  could  they  have  been  accessible  to 
all,  then,  indeed,  would  this  report  have  been  a  useless  undertaking;  but 
should  it  only  serve  to  direct  public  attention  to  them,  and  to  the  subjects 
of  which  they  treat,  will  much  good  have  been  accomplished. 

For  a  thorough  understanding  of  the  Scotch  system,  we  refer  the 
reader  to  the  interesting  work  of  A.  Mitchell,  M.  D.,  "  On  the  Insane 
in  Private  Dwellings." 

The  plans  that  we  have  selected  for  publication  in  this  report  are 
chosen  from  a  large  list,  and  are  believed  to  be  specimens  of  the  best  in 
the  world.  There  are  many  others  equally  good,  and  in  giving  prefer- 
ence to  these  we  by  no  means  intend  or  desire  to  disparage  others.  All 
cannot  be  published,  and  to  insert  an  account  of  so  many  asylums,  such 
as  w^e  find  in  our  notes,  would  constitute  a  volume,  and  must  therefore 
be  omitted,  however  agreeable  it  would  be  to  us  to  give  our  experience 
of  each  institution  visited.  We  must  therefore  be  content  with  descri])- 
tions  of  a  few  only,  as  samples  of  the  best,  and  again  refer  the  reader 
to  the  journals  and  other  works  on  the  subject  already  alluded  to,  for 
any  additional  information  that  may  be  desired. 

FARM    ASYLUMS. 

The  farm  asylum — of  which  Clermont,  Avith  its  colony  of  Fitzjames, 


224 

iibout  fifty  miles  from  Paris,  is  perhaps  the  best  specimen — possesses 
some  advantages,  in  an  economical  point  of  view,  but  would  scarcely  be 
applicable  in  this  country.  It  consists  of  an  asylum  proper,  situated  in 
the  Town  of  Clermont,. and  is  intended  for  all  patients  who  cannot  safely 
be  trusted  with  the  liberty  given  the  patients  at  the  colonies.  One  of 
these,  called  '•  Fitzjames,"  is  near  the  town,  and  is  approached  by  a  wide 
avenue,  finely  shaded  by  trees.  Here  there  are  several  buildings  appro- 
priated to  the  use  of  the  different  classes  of  patients,  who  pay  from 
thirty  francs  a  month  to  three  hundred.  Those  paying  the  higher 
prices  have  rooms  to  themselves,  a  larger  number  of  attendants,  better 
diet,  greater  facilities  for  amusements  and  entertainments,  and  are  not 
required  to  work.  Of  this  class  there  are  very  few.  Those  who  arc 
charged  thirty  francs  a  month  are  paid  for  by  the  Department  from 
which  they  came,  and  are  expected  to  do  such  labor  as  may  be  required 
of  them.  The  colonies  contain  one  thousand  acres  of  land,  and  the  men 
Avork  upon  the  farm,  in  the  garden,  and  in  the  shops,  while  the  women 
sew,  do  housework,  wash,  iron,  etc.  The  buildings  occupied  by  the  men 
Avho  work  on  the  farm  are  two  stories  high,  and  consist  of  day  rooms  on 
the  first  and  dormitories  on  the  second  floor.  They  eat  in  a  common 
dining  room,  and  no  classification  is  attempted.  The  flouring  mill,  barns, 
stables,' piggeries,  sheep  sheds,  fowl  yards,  butcher  shop,  etc.,  are  near 
these  buildings,  and  are  all  kept  in  the  most  complete  order.  They  are 
under  the  management  of  M.  Jules  Labitte,  one  of  the  three  brothers  to 
whom  the  establishment  belongs,  while  Doctor  Gustave  Labitte  is  the 
Physician  in  Chief  of  the  entire  establishment,  having  an  assistant  in 
each  department.  The  buildings  for  the  laundry  women  are  located  a 
few  hundred  yards  distant  from  the  last  mentioned,  and  are  of  similar 
character.  The  laundry  itself  is  so  constructed  that  a  little  river  or 
stream,  the  Beronelle,  traverses  its  entire  length,  and  presents  much  the 
appearance  of  an  ordinary  mining  flume,  on  either  side  of  which  the 
women  stand  and  wash,  after  the  custom  of  washerwomen  throughout 
France.  The  other  colony,  '•  Yilliers,"  is  about  four  miles  from  Cler- 
mont, and  is  conducted  on  the  same  principle  as  that  at  Fitzjames.  Of 
the  fourteen  hundred  and  seven  patients  at  this  establishment  three 
hundred  and  fifty  are  at  Fitzjames,  one  hundred  at  Yilliers,  and  the  rest 
at  the  establishment  in  Clermont.  It  is  said  to  be  a  most  profitable 
enterprise  to  its  proprietors,  and  we  were  impressed  with  the  idea  that 
the  patients  were  required  to  do  more  Avork  than  seemed  compatible 
with  their  physical  and  mental  condition;  and  the  fact  that  nineteen  and 
seven  tenths  per  cent  of  recoveries  and  forty-five  and  two  tenths  per 
.cent  of  deaths  to  numbers  admitted  were  reported  for  eighteen  hundred 
and  seventy  is  an  additional  reason  to  confirm  this  conclusion.  Ordi- 
narily the  labor  of  five  lunatics  is  supposed  to  be  equal  to  that  of  one 
person  in  perfect  health,  while  many  cannot  labor  for  medical  reasons; 
but  here  a  much  larger  proportion  are  required  to  work,  and  more  work 
required  of  them.  Hence  we  conclude  that  this  system  could  not  be 
successfully  carried  out  in  our  country  and  among  our  people. 

CLOSE    ASYLUMS. 

This  brings  us  to  the  consideration  of  the  close  asylums,  including  the 
corridor,  house,  and  pavilion  plans.  All  of  these  have  their  j^eculiar 
advantages  and  their  strenuous  advocates.  Plans  of  each  will  be  found 
in  Appendix  F  of  this  report.  All  have  notes  of  reference  explanatory 
of  the  design,  and  some  have  been  described. 


225 

The  asj^lnms  in  the  United  States  have  nearly  all  been  constructed 
on  the  corridor  j^lan,  with  centre  building  and  wings.  The  plans  of  the 
proposed  asj'luni  at  the  City  of  Boston,  the  Pennsylvania  Hospital  for 
the  Insane,  and  the  Michigan  State  Asylum,  though  dittering  in  some 
respects,  are  all  of  this  character,  and  are  considered  among  the  best  in 
this  country,  and  we  think  are  not  surpassed  by  any  in  the  world.  None 
of  them  could  be  built  for  less  than  one  thousand  six  hundred  dollars  per 
patient,  .and  the  Pennsylvania  Hospital  for  the  Insane — known  as  the 
Xew  Kirkbride  Asylum — with  all  of  its  appurtenances  would  probably 
cost  two  thousand  dollars  per  patient.  It  is  a  corj^orate  institution, 
intended  for  and  patronized  by  the  wealthy  or  independent  classes,  who 
pay  from  fifteen  to  thirty-five  dollars  per  week,  which  enables  it  to  fur- 
iiish  many  advantages,  comforts,  and  luxuries,  and  sources  of  amuse- 
ment and  diversion,  that  would  be  be^'ond  the  reach  of  institutions 
intended  mostly  for  the  accommodation  of  indigent  or  non-paying 
patients.     Its  ca2)acity  is  for  two  hundred  and  fifty  patients. 

The  Michigan  Asylum  is  a  State  institution  and  was  designed  for  three 
hundred,  and  cost  four  hundred  thousand  dollars;  while  the  plan  of  the 
Boston  Asylum  was  also  intended  for  three  hundred  patients,  and  was 
estimated  to  cost  four  hundred  and  ninety-eight  thousand  five  hundred 
and  three  dollars.  ^ 

Descrii:)tions  of  these  asylums  will  be  found  elsewhere  in  this  report, 
and  it  is  only  necessary  to  say  here  that  all  of  them  might  be  built  in 
such  manner  as  materially  to  lessen  the  cost  and  yet  retain  the  general 
design  of  the  structures  and  convenience  of  internal  arrangement.  We 
will  mention  a  few  of  the  most  prominent.  The  expensive  apparatus- 
necessary  to  forced  ventilation  might  in  our  climate  be  dispensed  with. 
It  is  rarely  cold  enough  in  California  at  any  season  to  render  it  neces- 
sary to  close  all  the  windows  of  a  hospital,  while  in  Summer  the  pre- 
vailing winds  afford  an  abundance  of  fresh  pure  air.  The  Boston  plan 
is  fifty-six  feet  Avide,  but  we  believe  that  thirty-six  feet  would  be  suffi- 
cient for  all  necessary  purposes.  This  would  give  twelve  feet  for  the 
corridors  and  ten  feet  in  the  clear  for  rooms — eight  by  ten  being  large 
enough  for  single  rooms.  Large  dormitories  we  do  not  and  never  did 
fancy;  one  in  each  w^ard  for  five  patients  would  be  sufficient  for  most 
classes  of  patients,  and  anything  larger  than  this  might  easily  be  pro- 
vided by  having  one  wing  on  either  side  so  constructed  as  to  have  the 
rooms  only  on  one  side  the  corridor,  after  the  almost  universal  system 
of  Great  Britain  and  the  continent,  as  may  be  seen  in  the  plans  of  Apper- 
dix  F,  figures  six,  ten,  twelve,  and  thirteen — the  connection  of  the 
wings  to  the  centre  building  and  to  each  other  giving  an  abundance  of 
light  and  air.  The  bay  windows  and  open  sitting  rooms  dt  the  end  of 
each  corridor  are  beautiful  and  most  desirable  features  of  this  plan.,  and 
worthy  of  imitation  in  any  new  structure  for  the  treatment  of  the  insane. 

In  the  Michigan  Asylum  the  ceilings  are  fourteen  and  sixteen  feet, 
which  we  think  unnecessarily  high.  Eleven  or  twelve  feet  would  seem 
sufficiently  high  for  the  wards  and  fourteen  feet  for  the  centre  buildings 
thus  saving  another  item  of  expense.  In  addition  to  these  items  that 
may  be  saved  without  sacrifice  to  comfort  or  design,  it  must  be  remem- 
bered that  in  our  temperate  climate  not  more  than  half  the  quantity  of 
piping  and  other  apparatus  for  heating  the  building  will  be  required  as- 
are  absolutely  necessary  in  the  colder  regions  in  which  they  are  located. 
A  most  desirable  feature  in  the  Michigan  Asylum,  too,  is  the  infirmary 

29 


226 

for  those  who  are  suffering  from  physical  diseases,  whether  connected  or 
not  with  their  mental  condition.  There  is  one  for  either  sex,  and  it  is 
often  a  great  comfort — sometimes  the  last — for  these  sufferers  to  have  a 
dear  relation  or  friend  with  them  in  such  times  of  trouble,  sickness,  and 
need. 

With  the  features  that  we  have  pointed  out  in  these  two  asylums,  and 
with  the  wards  for  excited  patients  as  they  exist  at  the  Pennsylvania 
Hospital  for  the  Insane,  combined  to  make  one  asylum  for  two  hundred 
and  fifty  patients,  supplemented  with  detached  buildings,  as  elsewhere 
suggested,  for  one  hundred  and  fifty  more — such  for  instance  as  are 
being  adopted  in  most  of  the  first  class  asylums  of  Great  Britain  and  the 
continent,"^  we  are  confident  that  no  better  plan  could  be  found  in  the 
world — whether  for  the  purposes  of  cure  or  comfort;  nor  can  we  see 
any  reason  why  such  an  establishment  may  not  be  as  cheaply  con- 
structed as  any  other. 

In  making  these  suggestions  and  giving  preference  to  the  asylums  of 
our  own  country  for  the  main  building,  we  do  not  wish  our  kind  and 
enlightened  friends  "  on  the  other  side  of  the  water  "  to  conclude  that 
we  have  failed  to  appreciate  the  admirable  features  of  their  institutions. 
It  is  true  that  we  have  expressed  our  disapprobation  of  their  congre- 
gated System — the  common  dining  halls  and  large  associated  dormi- 
tories— because  we  believe  them  to  be  incompatible  with  proper  classifi- 
cation. It  seems  to  work  remarkably  well  in  that  country,  where  classes 
in  society  are  distinctly  divided,  and  where  most  of  the  poor  are  kept  in 
asylums  prepared  especiall}^  for  their  reception  and  accommodation, 
while  the  independent  patients  are  sent  to  hospitals  suitable  to  their 
social  condition,  either  in  separate  institutions  or  separate  buildings 
under  the  same  superintendence.  There,  too,  the  people  are  more  accus- 
tomed to  regard  those  vested  with  authority  its  superior  beings,  entitled 
to  command,  and  an  inherent  right  to  be  obeyed.  These  ideas  are  rather 
strengthened  than  otherwise  by  insanity,  and  are  carried  into  the 
asylum  with  them,  causing  them  to  submit,  without  complaint,  to  the 
rules  of  the  asjdum  and  to  the  orders  of  those  placed  over  them.  The 
English  and  continental  asylums,  therefore,  may  be  well  adapted  to  the 
treatment  of  patients  thus  constituted,  but  in  our  country  the  case  is 
very  different.  Every  man  considers  himself  as  good  as  any  other,  and 
generally  claims  that  he  has  as  much  right  to  command  as  those  whom 
he  may  have  assisted  to  place  in  authority.  Our  people  have,  in  their 
condition  of  health,  an  exalted  idea  of  liberty,  which  is  only  perverted, 
perhaps,  by  insanity.  To  be  thwarted  in  their  designs  or  restrained  in 
their  actions  is  conceived  to  be  a  trespass  upon  their  inalienable  rights, 
a  curtailment  of  their  freedom,  which  tends  to  excite  and  exasperate 
them.  We  cannot  bring  them  together  with  impunity  in  such  numbers 
as  they  are  in  other  countries;  besides,  in  this  country,  wnth  lew  excep- 
tions, the  asylums  receive  alike  the  rich  and  poor,  the  cultivated  and  the 
ignorant,  the  refined  and  the  vulgar,  who  can  only  be  separated  by  our 
corridor  system,  where  each  ward  constitutes  its  own  little  family,  with 
their  own  sitting  and  dining  room,  parlor,  bath  room,  etc.,  which  would 
be  impossible  with  the  English  system.  We  are  well  aware  of  the 
advantages  of  the  day  roonis  of  the  European  asylums,  which  enables 
the  dormitories  to  be  vacated  during  the  day  and  thorougly  aired  and 
ventilated.  Hospital  odors  are  less  liable  to  accumulate,  to  become 
offensive  and  unhealthy,  and  it  may  be  that  the  patients  learn  the  better 
to  control  their  feelings  and  their  actions  by  being  brought  in  daily  con- 
tact with  a  larger  number  of  their  fellows.     Indeed,  we  are  disposed  to 


227 

think  that  a  modification  of  our  system  in  this  respect  might  he  made 
with  advantage — that  there  might  be  one  hirge  dining  hall,  not  for  all, 
or  for  three  fourths,  but  for  one  fourth  of  the  j^atients  in  our  asylums, 
where  the  men  and  women  who  were  well  enough  and  who  desired  to 
do  so  might  meet  and  take  their  meals  together.  There  is  at  present  but 
one  asylum  in  the  United  States  (at  Staunton,  Virginia)  where  this  is 
done,  and  we  were  assured  by  Doctor  Stribbling  that  it  was  considered  a 
great  privilege  by  the  patients,  who  used  extraordinary  efforts  at  self- 
control  that  they  might  not  be  deprived  of  it.  Seventy-five  out  of  three 
hundred  and  fiftj^  patients  were  deemed  proper  subjects  to  be  thus 
brought  together,  regardless  of  sex. 

PAVILION    PLAN. 

The  Virginia  Asylum  of  which  we  have  spoken,  more  nearly  than  any 
other  in  this  country  resembles  the  pavilion  system  now  so  generally 
adopted  in  all  the  new  asylums  that  we  saw  in  France,  either  as  recently 
comj^leted,  or  in  process  of  construction,  and  of  which  the  asylum  at 
Auxerre  (see  plan  Apj).  F,  fig.  14),  may  be  considered  a  specimen.  The 
plan  recommended  by  the  German  Superintendents,  and  adopted  by  the 
authorities  for  the  new  asylum  at  Berlin,  is  also  on  the  pavilion  system. 
Many  of  the  more  recently  constructed  asylums  in  Great  Britain  have 
also  adoj^ted  this  plan  to  some  extent,  by  suj^plementing  the  main  hos- 
pital with  detached  blocks,  such  as  we  have  suggested  for  a  new  asylum 
in  California. 

The  asylums  at  Brookwood,  Brentwood,  Glamorgan,  Warwick,  Glou- 
cester, Colney  Hatch,  Wakefield,  The  Friends'  Eetreat,  Newcastle  on 
Tyne,  Cumberland  and  Westmoreland,  Morningside,  Cupar  and  Fife, 
Glasgow,  the  Eichmond  Asylum  near  Dublin,  Cork,  Quartre  Mare, 
and  the  new  Asylum  San  Yon  at  Eouen,  Saint  Ann  at  Paris,  and  many 
others,  are  either  entirely  on  the  pavilion  plan,  or  are  supplemented 
with  detached  blocks  or  cottages.  The  McLean  Asylum  at  Somervillle 
near  Boston,  is  another  sample  in  our  country;  though  we  think  the 
detached  blocks  in  this  asj'lum  too  small  to  be  used  profitably  or  with 
advantage  in  a  State  institution,  as  none  should  be  built  so  small  as  to 
require  less  than  two  or  three  attendants,  that  at  least  one  may  be  ever 
present  in  each  ward  where  patients  are  kept.* 

In  addition  to  this  feature  as  taken  from  the  European  s^^stem,  we 
cannot  too  strongly  urge  the  adoption  of  another,  which  to  our  mind  is 
the  most  charming  of  them  all — we  allude  to  the  extensive'and  beautiful 
pleasure  grounds  by  which  the  asylums  of  the  Old  World,  and  especially 
those  of  Great  Britain,  are  surrounded.     The  bright  and  beautiful  lawns, 

*  For  further  information  on  the  pavilion  system,  see  Journal  of  Mental  Scieyice,  for 
January,  eighteen  liundred  and  sixty-seven,  an  interesting  paper  by  Doctor  Lockhart 
Kohertson,  read  at  the  annual  meeting  of  the- Medico-Psychological  Association,  held  in 
Edinburgh,  July  thirty-iirst,  eighteen  hundred  and  sixty-six.  Doctor  Eobertson  is  the 
able  and  well  known  editor  of  the  Journal  of  Mental  Science,  ex-President  of  the  Medico- 
Psychological  Association,  and  for  many  years  Superintendent  of  the  Asylum  at  Hay- 
Avard's  Heath. 

The  opinions  of  the  distinguished  psychologists  of  Germany  will  be  of  peculiar  interest 
to  all  who  can  read  German.  Indeed,  the  shelves  of  our  library  now  contain  the  opinions 
and  suggestions  of  the  ablest  and  most  experienced  men  who  have  written  on  this  subject, 
not  only  with  regard  to  asylums,  and  hospital  construction,  but  upon  all  subjects  in  any 
way  related  to  or  connected  with  insanity. 

The  admirable  Keports  of  the  Commissioners  in  Lunacy  for  England  and  Wales,  Scot- 
land and  Ireland,  are  full  of  information  and  interest.  We  again  invite  especial  attention 
to  these  works. 


228 

handsomely  laid  out  and  planted  with'  shade  trees,  shrubs,  and  flowers, 
impress  the  beholder  with  satistaction  and  delight,  and  must  produce  on 
the  mind  of  the  patient  and  his  friends  a  feeling  of  pleasurable  relief, 
that  the  bare  walls  of  a  hospital,  however  beatifui  in  design  and  elegant 
in  structure,  can  never  aftbrd. 

It  may  be  well  in  this  connection  to  state  that  no  asylum  in  Great 
Britain  or  upon  the  continent  is  built  more  than  three  stories,  and  in  our 
opinion  none  should  ever  be  in  this  or  any  other  country.  The  centre 
building  may  be  three,  the  first  wings  should  be  two,  and  the  last  but 
one.  If  covered  with  a  French  roof,  the  attic  may  be  utilized  either  for 
dormitories  for  quiet  chronic  cases  or  for  such  other  purposes  as  may  be 
desired.  No  ward  should  be  built  without  a  wide  stairway  of  iron  or 
stone  at  either  end,  that  free  escaj^e  in  case  of  fire  may  always  be  made. 
For  the  want  of  this  necessary  precaution  many  patients  have  lost  their 
lives  in  the  numerous  fires  that  have  occurred  in  the  last  lew  years  in 
our  own  country.  We  ourselves  have  had  two  fires  at  Stockton  within 
the  last  fifteen  months,  but  fortunately  not  in  the  asylum  wards.  In  the 
first  instance  the  laundry  was  burned,  and  in  the  last  an  outhouse  used 
as  a  hayshed,  and  had  the  wind  been  from  a  different  direction  the 
wooden  cottages  in  which  patients  are  kept  might  have  been  consumed 
with  the  rest. 

We  learn,  too,  that  the  private  asylum  of  Doctor  Chipley,  near  Lex- 
ington, Kentucky,  has  just  been  destroyed  by  fire.  This  admonishes  us 
that  we  cannot  guard  with  too  much  care  against  the  danger  and  rava- 
ges of  this  fearful  and  devouring  element. 

Our  views  with  regard  to  the  kitchen,  chapel,  laundry,  airing  courts, 
etc.,  are  in  -entire  accord  with  those  expressed  by  Doctor  Manning,  as 
previously  noticed  in  this  report.  It  is  therefore  unnecessary  to  sjDeak 
of  them  here. 

With  an  asylum  of  this  kind,  carefully  watched  during  its  construc- 
tion that  the  endless  details  from  a  closet  to  a  doorlock  may  neither  be 
overlooked  nor  neglected,  and  so  located  as  to  possess  all  the  advantages 
we  have  pointed  out,  the  most  favorable  results  may  reasonably  be 
expected.  And  if  in  addition  to  this  we  could  only  have  a  small  asylum 
for  the  treatment  of  such  of  our  citizens  as  may  desire  better  accommo- 
dations than  the  State  can  afford  to  give,  our  system  would  be  as  near 
perfect  as  i\\\j  in  the  world.  There  would  then  be  no  jealousies  on  the 
part  of  the  poor,  and  no  complaints  on  the  part  of  those  who  pay.  The 
rich  would  have  such  accommodations  as  they  desired  and  were  disposed 
to  pay  for  at  rion-speculative  rates,  and  the  poor  would  be  as  comfort- 
ably provided  for  as  in  any  other  country.  As  already  stated,  we  can 
scarcely  hope  that  provision  will  be  made  for  the  execution  of  this  last 
suggestion  at  the  present  time.  The  others  are  absolute  necessities, 
requiring  immediate  action  or  disastrous  consequences,  while  this  is  only 
a  desirable  end  devoutly  to  be  wished  for  but  not  of  absolute  and  press- 
ing necessity. 


CONCLUDING    EEMAEKS. 

In  our  introductorj'  chapter  we  expressed  our  obligations  to  all  who 
had  contributed  to  our  stock  of  information  or  facilitated  our  investiga- 
tions. We  feel  that  something  more  than  this  is  due  from  us,  not  only 
for  courtesies  extended  in  consequence  of  our  position  as  an  officer  of 
the  State  of  California,  but  for  individual  acts  of  kindness. 


229 

The  Commissioners  in  Lunacy  for  England,  and  Wales,  and  especially 
Mr.  "VVilkes,  in  addition  to  valiuible  contributions  for  the  State  Library, 
gave  us  information  that  greatly  aided  us  in  our  investigations.  Doctor 
Mandsley,  the  President  of  the  Medico-Psychological  Association  of 
Great  Britain,  kindly  invited  us  to  attend  the  annual  meeting  of  that 
body,  and  thereby  brought  us  in  contact  with  a  large  number  of  the 
most  able  and  learned  men  in  the  country,  and  enabled  us  to  exchange 
views  with  and  obtain  the  experience  of  such  men  as  Doctor  Bucknill, 
the  accomplished  author  and  Chancery  Commissioner  in  Lunacy;  Doctor 
Lockhart  Eobertson,  also  a  Chancery  Commissioner,  and  editor  of  the 
Journal  of  Mental  Science;  Doctor  Tuke,  the  Secretar}^  of  the  Associa- 
tion," and  Doctors  Arlidge,  Blandford,  Sankey,  Hood,  Monroe,  Clouston, 
and  others  whose  writings  are  familiar  to  the  profession  in  this  country, 
and  a  large  number  of  Superintendents  of  asylums  from  all  parts  of  the 
kingdom.  Many  of  these  we  had  seen,  or  afterwards  visited  at  the  asy- 
lums under  their  management.  Doctor  Brushfield,  at  Brookwood;  Doctor 
Begley,  at  Han  well;  Doctor  Marshall,  at  Colne}^  Hatch;  Doctor  Phys 
Williams,  at  Bethlem;  Doctor  S.  W.  D.  Williams,  at  Hay  ward's  Heath; 
and  that  noble  trio  of  genial  gentlemen,  Doctors  Yellovvlees,  Clouston, 
and  Eogers,  who  reminded  us  so  forcibly  of  three  young  Superintendents 
in  our  own  country — Doctors  Eodman  of  Hopkinsville,  Kentucky,  Cal- 
lender  of  Tennessee,  and  Walker  of  Boston.  Doctor  Forbes  Winslow 
did  not  attend  the  meeting  of  the  Association,  but  we  had  the  pleasure 
of  seeing  him  at  his  owm  home.  He  is  a  man  of  such  versatility  of 
genius  and  such  a  fund  of  knowledge  that  to  be  in  his  presence  is  to 
imbibe  information.  We  are  under  many  obligations  to  him.  A  host  of 
othei;s  were  equally  kind  and  hospitable,  and  to  whom  we  gratefully 
tender  our  thanks. 

In  Scotland,  our  obligations  are  due  to  Sir  James  Coxe,  one  of  the 
Commissioners  in  Lunacy,  and  President  of  the  Medico-Psychological 
Association,  for  courteous  attention  and  valuable  reports.  To  Doctor 
Sibbald,  Deputy  Commissioner  in  Lunacy,  for  devoting  an  entire  day  in 
visiting  with  us  the  Colony  of  Kennoway,  where  insane  persons  are 
kept  in  private  dwellings,  after  the  fashion  of  Gheel  in  Belgium;  and 
also  for  a  copy  of  his  essay  on  the  cottage  system.  Doctor  Mitchell's 
treatise  on  the  insane  in  private  dwellings,  and  other  documents.  To 
Doctor  David  Skae,  the  celebrated  Superintendent  of  the  Morningside 
Asylum,  for  giving  us  the  results  of  his  treatment  in  some  cases  of 
insanity,  together  with  the  effects  of  certain  remedies  elsewhere  consid- 
ered; and  to  the  SuiDerintendents  of  all  the  asjdums  visited,  for  similar 
favors. 

Doctor  Stew^art,  of  the  Belfast  Asylum  in  Heland;  Doctor  Lalor,  of 
the  Pichmond  Asylum  at  Dublin;  Doctor  Murphy,  at  Killarney;  Doctor 
Nugent,  one  of  the  Inspectors  of  Asylums,  and  other  gentlemen  engaged 
in  the  specialty,  also  placed  us  under  obligations. 

In  France,  to  Doctor  Blanche  of  Passy;  Doctor  Lasegue,  President  of 
the  Medico-Psychological  Society  of  France;  Doctor  Motet,  the  Secre- 
tary of  the  Society;  and  to  Doctors  Falret,  Dumesniel,  Morel,  Foville, 
Dagonet,  Labitte,  Arthaud,  Carrier,  Bruno,  Hildebrand,  and  Ceilleux,  we 
are  indebted  for  many  courtesies  and  all  the  information  we  were  able 
to  obtain  of  the  condition  and  treatment  of  the  insane  in  that  country. 

In  Italy,  Doctor  Fidele,  of  Pome,  not  only  accompanied  us  to  the  asy- 
lum but  to  the  numerous  hospitals  and  other  charitable  institutions  of 
the  Imperial  City,  and  gave  us  letters  to  several  of  the  prominent  phy- 
sicians throughout   the    kingdom.      Professor  Neri  of   Perugia,  whose 


230 

asylum  overlooks  the  broad  Valley  of  the  Tiber,  gave  us  the  only 
general  statistics  that  we  were  able  to  obtain  in  Italy,  and  was  not  only 
well  versed  in  psychological  medicine,  but  was  imparting  his  information 
to  a  class  of  twenty  medical  students  who  w-ere  studying  the  diseases  of 
the  brain  that  affect  the  mind.  Doctor  Cardini,  of  Florence;  Doctor 
Fouscarti,  of  Bologna;  Doctor  Biffi,  of  Milan;  Doctor  Salerio,  of  Venice; 
Doctor  Bramanti,  of  Padua,  and,  indeed,  all  the  physicians  and  Superin- 
tendents whose  asylums  we  visited  cheerfully  opened  to  us  the  doors  of 
their  institutions  and  aided  us  in  every  possible  manner  in  the  prosecu- 
tion of  our  inquiries. 

Nor  can  we  say  less  than  this  of  the  Superintendents  of  the  asylums 
in  Bavaria,  in  Austria,  in  Prussia,  and  in  other  German  States,  in  Swit- 
zerland, in  Holland,  and  in  Belgium. 

Nor  can  we  forget  the  services  rendered  us  in  our  visits  to  the  German 
and  Swiss  asylums  by  our  young  and  accomplished  countryman,  Doctor 
B.  B.  Kent  of  Boston,  w^ho  accompanied  us  to  a  dozen  institutions,  and 
from  his  knowledge  of  medicine  and  of  the  German  language  added 
greatly  to  the  interest  and  pleasure  of  our  investigations  and  our  travels. 

To  the  United  States  Ministers,  Mr.  Marsh,  in  Italy;  Mr.  Jay,  in  Aus- 
tria; Mr.  Bancroft,  in  Prussia;  Mr.  Washburne,  in  France;  Mr.  Jones,  in 
Belgium;  and  the  acting  representative  of  our  Government  in  England, 
Mr.  Moran ;  and  to  the  Consuls  of  the  United  States,  wherever  and  when- 
ever called  upon,  we  are  indebted  for  favors  of  various  kinds.  They 
were  ever  ready  to  assist  us  in  our  investigations  in  every  j^ossible  way. 

It  is  scarcely  necessary  for  us  to  say  more  of  the  Superintendents  in 
the  United  States  than  that  they  are  all  intelligent  men,  devoted  to  the 
cause  of  humanity,  and  equal  in  every  respect  to  those  of  any»  other 
country.  Among  them  are  men  of  worldwide  reputation,  such  as  Doc- 
tors Pay,  Jarvis,  Earle,  Gray,  Butler,  Kirkbride,  Stribbling,  Nichols, 
Bancroft,  Pead,  Buttolph,  Gundry,  Curvv^en,  and  Workman  and  others  are 
well  known  in  our  own  country.  To  all  of  these  gentlemen  we  owe  and 
herewith  tender  our  thanks;  and  to  our  friend,  Doctor  Edward  Jarvis, 
who  not  only  gave  us  free  access  to  his  splendid  library,  but  who  ren- 
dered us  invaluable  assistance  in  various  ways.  He  is  a  faithful  worker 
in  the  harness  of  humanity,  and  deserves  the  gratitude  of  the  human 
race.  There  are  many  others  to  whom  we  are  indebted  for  counsel, 
assistance,  and  good  cheer,  and  to  these,  with  the  rest,  we  offer  our 
thanks.  If  there  is  any  one  man  in  this  State  who  more  than  any  other 
is  entitled  to  the  gratitude  of  the  unfortunate  class  of  our  citizens  in 
whose  behalf  we  have  pleaded,  that  man  is  our  friend  Colonel  E.  J. 
Lewis  of  Tehama,  who,  sympathizing  with  their  misfortunes  and  com- 
prehending their  sad  condition,  introduced  the  bill  authorizing  this 
inquiry  in  order  that  public  attention  might  be  directed  to  their  necessi- 
ties and  relief. 


APPENDICES 


[Appendix  A.] 


UNITED    STATES. 
Table  1. 


Shoioing  admissions^  with  principal  causes  of  Insanity,  and  per  cent  of  each 
to  admissions,  in  twenty-six  Asylums,  in  eighteen  hundred  and  sixty-nine. 


In  five   thousand  three   hundred   and   fourteen    admissions,   the 
principal  causes  of  insanity  were: 

111  health  and  physical  disease 

Spermatorrhoea 

Domestic  trou bles 

Intemperance , 

Eeligious  excitement 

Epilepsy 

Per  cent  of  each  on  number  of  admissions: 

111  health 

Spermatorrhoea 

Domestic  troubles 

Intemperance 

Eeligious  excitement 

Epilepsy 


1486 
708 
544 
544. 
527 
357 


27.96 
13.32 
10.23 
10.23 
9.91 
6.71 


Showing,  also,  the  Deaths,  loith  pri?icipcd  causes,  and  per  cent  of  each  to  total 
Deaths,  in  twenty-seven  Asylums,  in  eighteen  hundred  and  sixty-nine. 


In  one  thousand  and  seven  deaths,  the  principal  causes  of  death 
were: 

Disease  of  the  lungs 

Paralysis 

Exhaustion,  from  different  causes 

Mania 

Marasmus 

Old  age 

Per  cent  of  each  on  number  of  deaths: 

Disease  of  lungs 

Paralysis 

Exhaustion > 

Mania 

Marasmus 

Old  aire 


162 

111 

107 

51 

40 

38 


16.08 

11.02 

10.62 

5.06 

3.97 

3.77 


30 


234 


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•  c 


5  c/j  x'  -y.  -y/  a/  ■/."  ^  r-  O  a.  <-._,.;_  .^    ^  •  — 


240 


Proportion  per  cent  of  '  ^,r~  g  g  g  5^ 
Deaths  to  Number  |  ,-i'  i-"  cc  -o  >5 1- 
Treated i       " 


-C  C'l  X  - 1  T  fO        rj-  l::  X  O  1^ 


Proportion    per   cent    of 
Deaths  to  Admissions... 


Proportion  per  cent  of 
Kecoveries  to  Number 
Treated 


IC  i-H 

X  X 

ccx' 

0  0 

is 

8  X  ?i  i  ix  '^ 

X  !>] 

CO  cc 

0  0 

(M  Tf^  ■M  M  CM^ 

irt  .-  1-  -.  X  I- 

cc  x'  "*  irt  ;£  ri 

(M  Tr<  -r  ri  VJ1  CM 

^  1^  --C  'N  J3 

•-£  CM*  C-i  -M*  x' 

c-^  u-:  TT  -*  (M 

Proportion    per  cent   of 
Eecoveries  to  Admis- 


Total.. 


<       -^ 


X'tt*  »*ICi  r-lO  (Mut^CCMrtlCC  OC^-M 

Females ..."'"'  ^-h     ^  <-i  ->c 


Males 


Total 

i^ 

Sg 

S^2 

.-1  Ci  01>rti  ^ 

C5  rc  0      "^  -ti 

^^l^i^ 

Females ... 

iSS 

c^ 

S^ 

ss^-^S^ 

?1S|  1^ 

Males 

1^ 

s^ 

=  ?i' 

;^^g=^^,?? 

gSS  i^ 

Total 

1,885 
499 

CO  oi 

CO  Tr 
Cv|  lO 

c§ 

0  ^ 
i2^ 

^  -t  X  c: 

1-  -T  Ci  -r 
•^!M  Ol  L.O 

0  --i  t-  UO  X 

Females  ... 

ss 

^g 

S 

220 
IK) 
148 
404 

IIS  ii 

Males 

C:  0 

^  CO 

gg 

1^ 

mm 

288 
288 
440 

Numbers  admitted. 


Or-i-^t^TfiO        OOl^COCX' 


Tfli-I  (M  1-1         Cv|         CM 


Numbers  resident. 


cooo      OQO      T+loo      cot^i^-rf-ci      ooooqo 

LO  O         X  so         UO  1^         (M  X  i-O  .-(  O  -O         Tfi  CO  X  L-O  (M 
X  CO         M  CO  .-H         CO  -4  Ol  Ol  01  CO         CO  CO  -.c         UO 


2     o.      ^ 

o 


X 


tlr^      c^       cc       ^-'-y'-'^-'c 

i^^flH  p^.^  ^^  p^^-  ^  -'- 


<  Jill  il'l^a-l^ 


241 


CO -* 


o  o 


(MQOOOOOCOOO        COOOeOCCiOI^CiOOO        t^co 
»-H  :0  X_  L.O  CN  IQ         IC  O  0-]  CO  CO  -:JH  :q  O  C^J         t-^  1-H 

CO  wi  CO  00  <0  CO    CD  1-^  '^  CO  CO*  00  f-H  1-^  lO    l-"^  CO 


CO  1^  '^  CO 


COOiCCOQOOi         (MCOOi«iCi-ICO-*ICi 
IC  00  "«0  -•:  O  1-;         1--  (>|  CO  as  O  CO  T-H  C5  Tfi 

ci  ic  i-^  CO  o  -^       -•-•-•-•-•-•   -•   -• 


00  CO  --I  CO  CO  o 
O  CO  lO  CO  ^  CN 
(M*  CO*  ci  i-O  oo'  lO 

CO  CO  CO  Tj<  Ol  -# 


T-HrHCiOlCOCOlOOO 
Oq  r-i  Oi^  Oq  CO  wJ  1-;  OO  ^ 

Tt^'  CO  QO'  1-'  C»  ci  Co'  ci  O 

Tt^  CO  :rj  ^  i-H  '■^j  ■*  CI  CO 


cooi-icoco      cO'-ir:icot^co      C5^C5r-c<ti  -^I'l^  i-i  'f* 

LOCOOODCO         ^'^i-^COCOCO         ^O-*l>0i— iCiGTi— lOl 
rHT-(r-l  1-1-  r-(  rHCq^ 


_r  o 


G  rt  ^,  :3p  - 

;^  c  ?^     -St!  c 

,  .  "^  :?  ^       oj  5  o 


03 


bcSl3  5 


^  ^  C!   cs  r;5         ^ :  -^ 


■3i 


o  O 


i-2r2 

- 

S§5 

i^S 

o  ^00  00    : 
00  o  th  G-q    : 

^§      j 

§ 

CO'Tt^ 

CO  o 

r-l  I^ 

00  o 

i^25 

N?^ 

o  i^  rH  CO    : 

CO  ^  CO  <M    : 

^^      1 

3 

g^ 

C0  01 
CO  l^ 

1-H 

r 

1^ 

CO  GO  Cr  Ci  t^  CO 

O  CO  O  "*  !;-■ 

CO'  •+!  ^  lO 

CN 

CO  00 

^3 

^V5 

I— 1 1— 1 

HE 

1—1 

coco  CO  rH       . 

ic  oi    : 

i 

rH  lO 
1^  CO 

COOl 

CO  CO 

O  -*0  Ci 

-HCOO   rH 

CO  C<l  t-H  rH 

o  CO  -+I  ic    : 

GO  (M    : 

CD 
rH 
CO 

9^:^ 

^oq 

rfl  CO  r- 

J^ 

rH  r-l  r-l   i-H  tH 

^o§igi2:^§§;^ 

CO  <M  rH  rH         CO  -*  1^  CO 

m 

oo" 

O  CO  t^ 

Cq  rH 

5ir, 
339 
237 

S 

C-lOOrHCCCNCirtltOrH 
OD  O  !M  1-  S  C^W  O  C5 
CO  CO  TjH  rH  (N  Cq  CO  "*  Oq 

n 

31 


242 


Ul 

T^ 

s 

se 

H 

•^ 

< 

. 

CO 

■^ 

S 

H 

t-S 

Ul 

a 

^ 

H? 

^ 

P 

M 

S 

•^ 

H 

^- 

1— ( 

53 

}^ 

i 

P 

1 

Proportion  per  cent  of 
Deaths  on  number 
treated  

10.75 
10.55 

:  ^ 

.  CO 

:  ^ 

:  o  CO 
:  i>:  CO 

;  C-i  00 

Proportion  per  cent  of 
Deaths  on  number 
admitted 

:  o 
:  o 
:  00 
:  ^1 

:  o  o 
:  r-i  c<i 

:  '—1 T— 1 

:  CM  Ci 
:  CM  ^ 

:  CO  Tis 

CM 

Proportion  per  cent  of 
Cures    on    number 
treated  

.O  C5 

CO  -^* 

T— 1 

*  1—1 
:  »o 

:  CO 

:  o  1-1 

.  CO  o 

•  a:  CO 

.'  CO  (M 

:  00  CO 
:  o  o 

:   Tt   rH 

Proportion  per  cent  of 
Cures    on    number 
admitted 

1-!   S<J 

fo  CO 

'•  CO 

:  CO 
:  CO 

CO  t- 

CO    '-H 

c:  CO 

'  c:  o 

'M  00 

:  — ■  in 

.  CO  CM 

dumber  Eemaining... 

^23 

1      !N"umbpr  Diprl  

O  CO 

T— ( 

^-  O 

CM  (M 

00  w 

:  CM  o 

1 

1 

1     ISTum 

1 

ber  Cured 

o  CO 

O  1:- 

r-H    CO 
CM   rH 

*  CO  o 
CO  t^ 

1 
1 

!         IS 

i      2 
En 

1 

Total 

t-  GO 

r-T 

-+  CM 

rH    O 
1— J^t- 

CO  00 
Ci  t- 

o 

Female 

■  o 

:  ^ 

•  ^ 

:  c» 
:  CO 

'M 

Male  

OC  00 

tH 

■§ 

-1^ 

!     Number  Admitted.... 

i 

00  'M    : 

00  CO    : 

CO  m 

o  o 

^1  00 

Number  Kesident 

i-HOOiC-MOOCOt-OOi-iO 

o  c-i  T-H  cvi  ct  c^t  cvi  o  oo  Ci  ?c  r-'D 

< 

c5 

1 

3 

1 

o 

5 

o 

o 
o 

O 

-)   , 
o 

1 

.o 

o 

1 

c; 

T— 1 

o 
o 

1 

t— 
c 

> 

m 

c 

ci 

:3 

CE 

o 

2 

> 

p 
o 

bi 

">< 
o 

■J 

243 


'^  M  r-l  :D  t-  tH  O  b-  <M  !M  tH  lO 

t hf  O  Thi  O  C^l  lO  Tt<  (M  O  r-l  CO 

l>^Gf6iLOOo6cOTt^o6o6rHi-5iO 

3 

00 

:  CO 
:  -^ 
:  CO 

OCOCCCOOsOOOTHOOt-COO 
OCOr-HCO-^O^Ort^OOOO 

o  o  o  CO  i>^  o*  id  "Tt^"  t>-  oi  '-tH  »d 

(MT-lrHi-lTHTtli-lrHT-l           CvlrH 

o 

g5 

•  CO 

:  t- 
.    :  s^i 

;  1—1 

O  OO  b-  t- 

O  t-  t-  f>l 

0  O  -t  00 

01  (M  T-l 

r^  -H   W  t-  (M   CO  <M 
»J^  lO  CO  t-;  !>.  CO  C<1 

00  c<i  t-^  CO  ci  CO  ai 

rH   T— 1    T— 1             T— ( 

CO 
rH 

c 
a 

cr. 

'■  <M 

:  C5 
:  o 
:  CO 

CO  TfH  CD  lO 
CD  r-J  00  l>^ 
rH   T-3   ci  T^' 
»0  rf  (N  (M 

'  T-l  t-  CO  CO  CO  CO  CO 
:  t>^  t^  Oi  lO  O  lO  CO 

'  lO  rH  ci  o  CO  o  »d 

.  <M  tH  G^l  CO  lO  CO  (M 

T-H 

00 

.    :  ^ 

O  C^l  lO 
O  CO  o 
Th  CO  rH 

•  CO  00  lO  CO  O  CO  CO 
:  CO  t-  O'  O'  CO  O  lO 
:  Cq  rH  CO  (M  rH  CO   CN 

T- 

:  CO 

^TH00C0CO(M(MCOiOC0^00 

(Mcococo^TtiT-iT^icq       t-T-i 

:  CO 

S 

•  CO 

:  ^ 

iMCOC^lO      't-CO-^T-iOOrHi— 1 
COiOt— iiO      l!MC0Ci»OT— iCiCO 

lO 

•  CO 

:  o 
:  ^ 

O  O  CO  -^  O  Jt-  CO  CO  rH  »0  CO  CO 
T-H  CO  lO  O  CO  1-1  CO  '-fl  O  00  CO  CO 
C0t-l-COlOC0(MiOC0rHCOC0 

00 
CO 

CO 

:  r.0 

-H  ^  o  t- 
Tt!  t-  Ci  -rH 

^  CO  CO  CO 

t-   CO  lO   rH   O 
rf  CO  CO  CO  Ci 
tH   rH   CM 

00 

as 

rH 

-o 

rH 

:  ^1 

CO  CO  CO  t- 

CO  00  CO  o 
rH  CO  CO  (M 

O  O  00 
t-  TO  t- 

rH  rH  (M 

1^5 

00 

CO 

r-f 

T-H 

•  o 
:  CO 

;  1— I 

o-tir5(Mcoioo:)^coT-icoo 

CMCOl'-OCOOt-T-l'^COCiOl 
T-H   00  CO   C^l   G-l  rH           CO  rH           (M  t-H 

CO 

rH  CO  b-  tH  O  CO  .CO  (M  t-  Cq  Tf  Oi  rH  -f  CO  CO  O  CO 
OCOCOrHOt-COOCOrHOOfMCOlOCOrHLOlO 
C0rHC0T-irHC0C0^(M(MrH(MrHrHC0G<lS<lC^1 


.S  o 


^ 


m 

c3    02 


X3 

WH   '^ 


;_,     -«     32  i^ 

■4-=  l-H     2     ^"l^ 


C5 
CO 

.;:3   oQ  '^  .9 


^   o   o     ^  p^ 


^^   cf  g 


2  S  M  S  ^ 


Jl 


O^  rs'^i  ^  o  2  s  -- 


a  L  3  ie  o  c  g 
o   3   S  n^   ?5   o   ^ 


o 

1^  hH 


•  S    O 

^  o 


244 


Proportion  per  cent  of 
Deaths  on  number 
trentpfl       

O  tH  CO  o 
T^  CI'  GO  to 

id  'o  t-;  aj 

00 

CO 

■• 

co 

•cq  -^  o  — <  ^  o 

1-1  -Tf  o  iO  «r:  cj 

CO  ^"  C^■i  ^'  T^'  1>^ 

. 

Proportion  per  cent  of 
Deaths  on  number 
admitted 

^  Ci  on  '+^ 
cc  ir:  T-;  "o 

t^  id  i-i  L-^ 

T— 1   rH    CM   1— I 

CO 

T— 1 

CO 

CO 
CO 

'^   CO   rj^   1-1   O   rH 

CO  CO  1-H  Ci  ro  t- 
i>^  CO  '>i  T-H  CO  c<i 

1—1         CO  1— t         C^l 

Proportion  per  cent  of 
Cures    on    number 
treated  

8.85 
14.11 
10.7G 
19.10 

T— 1 

CO 

r-  CO  t-  CO  tH  TT^ 

CO.  lO  CO  ^1  ->!  O 

oi  id  c^i  o  T-1  rH 

1-1         G<J  C<l  (M 

Proportion  per  cent  of 
Cures    on    number 
admitted 

CO   O   rH   T— 1 

lo  oq  o  c<i 
Vy^  ^  ci  ci 
(M  re  (M  ro 

'M 

en 

-** 

^  CO  CO  CO  1-1  CO 

C^  T-i  -+  CO  CO  ^ 

c^i  o  r-^  ro  ci  o 

iT^  Cvl  (M  ii5  CO  CO 

iS'umber  Remaining.. 

CO      *  (M  iO 

3    :32 

CO 

cq  O  Ci  rt< 
CO  ro  iCi  -H 

-M  C.0  iO  lO 

iS'umber  Died 

t 

-+  lO  lO  I- 
-^  t-  t-  C<1 

T— 1 

CO  O  O  CO  -H  'M 
(M  CO  'O 

1     Xumber  Cured 

CO  O  CO  o 

CO  iO  O  CO 

T-H  r-l 

Cf) 

O   rH    CO    CO    O    iO 

c<i       o  o  CO 

rH  T— 1   rH 

Total 

-t:  -H  t-  -+ 
T-H  GO  lO  1-1 

CO  o^cr.  CO 

o 
en 

T— 1 

Ci 

o 

CO 

■  CO  lO  CO  o  ro  -t^ 
Ci  CO  iO  o  ir:  CO 

i-<  (M  iO  t-  t- 

Female 

O  Oi  t- 
CO  CO  CO 
T:^  tO  o 

ir:  G^i  o  -* 
'M  CO  en  CO 

rH   CM   CO   CO 

Male 

-i^  lO  o 
00  -rt^  Ci 

CO  ir:  CO 

00  t-  CO  o 
^1  -*  CO  o 
rH   M   CO   -* 

Number  Admitted.... 

t-  -H  lO  CO 

-:-f    CO    lO    lO 

c^i  Tt^  ro  T-i 

o 

CO 

I- 

t-  -M  CO  CO  t-  CO 
r^  L-  C^l  en  O  t^ 

rH   ^   (M 

I!^umber  Eesident 

t-CO^'-lGOOOO^MOClC.OiOCO-Or-i 
CO  O  O   O  GO  ^  ^  O  -*  CO  t-  CO  'M  -^  -^  ^ 
iO  CO  CO  1— 1          T—          rH  1—1                         S^l  CO  CiO  O 

CO 

1-: 

c 
c 

>- 

c 

r- 

c 

<; 

o 

DO 

o 
p 

or 

f— 1 

s 

• 

> 

o 

c 

pq 

D^ 

c 

c 
> 

c 

> 
c 

0 

245 


00  Ci  CD  Oi  'i*  CO   : 
(M  O  00  C^l  t-  L-   . 

cj  CO  CO  00  ci  'o  ] 

O  <M 

1-H  CO 

id  oi 

[ 

CO  CO  o  CO  CO  1-1  CO 

CO  lO  CO  CO  t-  O  !_■- 

CO  (>i  CO  00  id  CO  CO 

rH 

1—1 

I:-  O  t-  CO  ^  CO  * 
rt^  -^  G^l  ro  Ol  O   I 

CO  CO  -+^  00  r.-j  CO    : 

T— (  1— 1  CV|      (M  T-l    I 

1-1  ^  ' 
co-f    : 

r-i   CO  : 

CO  CO  CO  CO  CO  -H  CO 
CO  lO  O  CO  OO  O  CO 

■CO  ci  oi  CO  CO  ci  <M 

CO    (M  i-(  CO  rH  (M 

00  ' 

o 

00 
1— ( 

00  !>•  o  CO  as  b-  ^ 

Tt^  CO  oi  CO  r-j  CO  : 

»>;  CO  (Ni  CO  id  o  : 

rH  1—1  T—l  T—l     i—H   ; 

CO  I-    : 

^  o  : 
riH  CO    : 

1—1     ; 

rfH  »0  CO  CO  lO  CO  G<1 

lO  o  b-  CO  lO  OS  b- 

id  00  O  CO  CO  crj  ci 

o 

rH 

00  1—1  CO  CO  t-O  (M   ' 

t-  o  CO  CO  CO  CO  : 

-t  -,0  id  jH  t-^  CD 

CO  CO  CO  Tt<  1-1  (?q  : 

t-  CO   • 

ci  CO  : 
rH  CO    : 

CO  CO  CO  lO  Ci  -^  b- 

1— 1  T-l  O  'J+l  O  »0  'TJH 

oi  o  Ti^  id  CO  T-H  (M 

(M  CO  '^    CO  CO  CO 

tH 
00 

(^^ 

CO 

r-i   CO   : 

^1^1-1 

'O)  CO  o 

lO  lO 

00  Ci  lO  o  t-  o 

rH  O  CO  lO  O  CO 

lO  (M  00  1-1  Cq  to 

12,506 

t-  lO  1-1  CO  O  OD 
rH  CO  O    CO  CO 

rH  CO 

O  t-  CO  irO  -tH  (M  -+ 
Ttl    rH  1-1  rH  CO  -^ 

lO 
00^ 

1— r 

(M  -fl  t-  lO  O  O 
CO  C5  -rfH  1-1  CO  CO 
1—1 

•  CO  (M 

lO  (M  :o  CO  CO  CO  cr 
CO  CM  CM    1-1  lO  cj: 

3    b-  . 

)    lO 

CO 

co'^ 

CO.tH  Ci  1-h  00  C^l 
CO  t-  CO  CI  t-  CO 
1— 1  lO  T-H^   O  lO 
r-T 

•  to  (M 

:  CO  (M 
:  CM  CO 

•  1-1  CO  CO  O  rjH  cq  a 
.  CO  b-  CO  00  ^  CO  T 

:  CO  (>q  CO  T-l  CM  lO  cs: 

)   tH 

H     CO 

(M 

o 

lO 

CO 

:  CO 
:  1—1 

;  1—1 

•  CO  CO  rH  lo  CO  m  b 

:  o  -j^  t-  c;  CM  CO  ir 

:  CO  tH  1-1     rH  (M  T- 

5 

Ci 

•  T-l 

:  ^ 

CO 

:  CM  CO 

;  1—1 

•  CO  O  CM  lO  CO  t-  r- 
:  (M  CO  1-1  00  rH  CO  c 
:  CO  rH  <M     1-1  CM  -si 

<>- 
a 

5  CO  a 
H  CO  '>:: 

■1     r- 

)  00 

•  1-1  c 

:  00  c 

*  O  CO  Ci  O  (M  CO  -r 
:  (M  t-  lO  rH  rH  CO  C 

•  1— 1       r-i          1— 1  r- 

1 

H    <r 
:>   c> 
H   c^ 

c 

T— 

5 

rHC0C0OO'+lO'r^l(^^rtl00rHO'i^OCM'-t^ri^ 

OrHG\lirOrHCOC<l»OCOC:>'^rHOCMb-OCOlO 
cot-  ^CO  rH(M<M  OCMCO  CMCO^ 


O  9- 


.-t^^pM 


_r  ic: 


hH  ^  :ii;  '-^ 


o§ 


o  ^ 


72     GC 


ill^ll 


— '    cc 


02 

O 


SfSH5Whi^c3l^-<W?^^WJ^^^ 


246 


CAISTADA. 
Table  5. 


tzj 

>      O 

J 

^ 

t-^ 

^ 

1 

-1   G 

3      3      ^ 

L 

5 

M 

II 

f- 

sl. 

^^ 

:;: 

2j  • 

o^ 

5  o 

ti  2 

^2 

£^ 

-  2 

^ 

o 

^'S- 

CfS- 

5  ^ 

ASYLT7MS. 

3   ^ 
O 

~u 

•-4 

^2 

S 
2 

:^  o 

o 

1^ 

i^"" 

p 

G 

2  5 

:     Pj'     p  &j 

trt- 

3 

r 

i 

r'o 

;      ' 

5^- 

•    5j- 

:    t::'!     :    S:' 

ZD 

*:     i 

O 

:    o 

:    »  j    :    CO 

1869.                               1 

Halifax ' 

216        ' 

-9  1  33  i  ] 

L3 

295  ! 

41 

11 

16 

4 

Toronto 

518        ' 

17  !.  35  M 

26 

595  i 

45 

5 

33 

4 

Provincial  Asylum,  rrederickton 

238      i: 

iO  i  62  1  J 

50 

368  ! 

47 

16 

23 

8 

Prince  Edward'^  I-^land.... 

31        1 

25  ;  ] 

L7 

2 

66 

68 

30 

8 

3 

-X.  1  i±±\jsj   _i_iT_i.  r>  cix \^  »_  j.._it*jj.\.t« 

1870.                               1 

Halifax '.... 

245        ' 
509      V. 
289      1. 

ro    i 

24  1  ^ 

1 

24      i 
t6      [ 

t4      [ 

25 
J7 
56 

315 
630 
363 

34 

38 
35 

7 

7 

12 

35 
30 

29 

7 

Toronto ... 

5 

Provincial  Asj'lmn,  Frederickton 

9 

247 


P 


pa 
< 


PQ 


248 


oo 


o 

1:- 

00 


^ 

^ 
^ 


.        .  ^       ., 

^ 

c: 

o 

1—1 

OOrt^fMCiOCOCi 

CO 

CO  »o 

Per  cent  ot  Deaths 

O  tH  T-i  O  Ci  GO  t-^  O  <::2'  O  !>;  CC  CO  Tj-'  C5 

on  No.  Treated.... 

T— ( 

Per  cent  of  Deaths 
on  Admissions 

(MCOT-iCOT-fOrH^CCC5COCiO(M(M 

-**  1-?  TJ^  c<i  (?q  cc  o  Tji'  '^*  i>I  cc  00  rf"  ci  i>^ 

tHt^           i-HCOTt^TjHTtCOCMSvlCvlCCrH^ 

Per  cent  of  Cures  on 
Number  Treated.. 

i-it:-5<lGOC:)OCOCO^»rrC:'M»C)t-CO 

coot-^coroidtot^t-^ccc^iiOrHt^cd 

T— i           T— 1   C^a                                                  rH           rH 

Per  cent  of  Cures  on 

O  O  O  t-  — J  W  C^3  CO  !>;  lO  c^t  c:  c;  t-  o 
o  T-<  i>^  cj  ci  00  ci  CO  CO  ^'  <:d  1-H  o  o  G^i 

AdE  ■ 

mssions 

Tt^rt^CCT^^-l<^JC^ICOCOC.0COC<^rt^C^'DT^ 

lOOiOOt-Mt-rOt-i^CDCOOkOrH 

T^         COCOOOCOOOOiOCqcOCO         1^5 

Numbers  Died 

T-H    T— ( 

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T-iT^'^i-i(MT-Hroo:::;OTtc^iCi       tjh 

Numbers  Cured 

t-o:irHCc;oo^»o^ococoi-i»at-cOTiH 

t-^  t^  -D  OC  lO  (M  r-i  o  — 1  c;  CC  1-  00  O  CO 

Numbers  Treated ... 

t-  >3  Tji  iC  T—  iO  CC  CO  t-  CO  -f  t-  '-H  o 

!>f^f 

»r5ooocoir:co(Mc;ot-o^-f->cco 

Numbers  Admitted. 

COOCqcOi-iCvlOCOOCi^-^C^C^lO 
1— li— iC^lrH'^'^T— li— It— It— IT-Ii— 1           t-I 

Cq'  tH  rH  CO  CO  CO  CO  C:  O  C:  T-^  1-1  CO  t-  O 

^  1:-  ^  ITS  -t  CI  L-^  ^1  irt)  cr.  C^l  CO  CI  t-  'M 

H 

Total 

cor-i(>qrtcoo-ooicoqcoo       -* 

12; 

r-r<>f 

ft 

M 

« 

OC  CO  o 

—    CO   t-   OT   CO   r-    Ct   ^ 

o 

^ 

Females 

i^  X  'f  ■ 
CO         ^ 

CO   CO   ^   GO   CO  r-i   O  rH 
O^OT^CO   CO   CO   i-!   rH   CO 

s 

s 

T-<     — 

g 

1^ 

CO  CO  CO 

t-  b-  C^^  00  r-i  O  CO  (M 

CO 

'A 

Males 

1— 1  lO  1— 1 

^^Or^:o^CiOO 

00 

CO           rH 

'•,OC0C0C0(MrHrH(M 

rH 

> 

"i 

m 

d 

^ 

S 

^ 

>< 

> 

■^ 

o 

>^ 

I-* 

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2    *rH 

< 

§ 

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^ 

^s 

00 

r^ 

tH    G 

JC!^:^ 

"3 

"^  "^  „ao  -:f  o  £ 
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^J 

>  -5      "^  P  ;^  -=  P  ^'  5  .2  ^  c  =^  ^ 

1-^ 

^ 

p5 

w 

h-H 

'>^ 

^ 

w 

s 

f— 1  r—i 

5 

^ 

75 

A 

249 


t^  ci  ':o  z6  T'i  o  t-^  i>^  t^ 


oqoq^OrHcooosi:- 

O   l>I  O   G^  j   O  1-^  lO   rH   O 


CO 
00 


CO  00  tH  C<j  CO  o  -*  W  o 

cdrHididcoooicoTiH 


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OO-^lOrH  t-(t— (COt- 


i-lb-OOOOrHt-ClCOCO 
OOrhit-coiOi-wiTOOiO 

1>-  XQ   TjH    CO   rH   (M   CO  O  O 


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c^ixiT— iTtir-io':oocoio       CO 

^  T— I    T— t    1— <  CTj 


b-^Q0(Mai»OCiC0^ 

oococooiroco»oi>-Ci 


lOCOtOt-CiCOt^-tli— I 
T-i'iiOOOOOOOI>>t-t- 
CO  (M  i-i  O  1-10:} 


(M  tH  CO  CO  O  (M  (M  C75  CO 

b-  G^i  CO  c:  »o  o  00  Ci  01 

(M   (M   I— i  lO  rH  T— I   (M 


+^  CO 

'  3  CO 
p  CO 

O  r-f 

o  '^-^ 


o 

a 

111 

o   fl   cu 


rt   o   a 


32 


250 


P 


CO 


QQ 

Hi 

Total 

CO 

T-H 

CI 

iS 

00 

11,402 

47,375 

3,955 

2,759 

3,790 

10,504 

30,871 

13.5 

1 
! 

Pemales ..  | 

1 

CO 
CO 

co'^ 
1— t 

CO   rH 

CO  CO 

CO    : 

2,172 

1,298 
1,083 
5,153 

T— 1 

Males 

CO 
(M 

1— 1 

1^5 

o 

1,783 

1,461 
2,107 
5,351 

PRIVATE.                         PAUPER. 

Total 

(M        : 
(M         : 

i 

1 

1     .J        : 
Females..       ^.        [ 

T— 1         : 

i 

1 

i 

o        : 
CO        : 
Males t^. 

1        CO 

T-H 

i 

Total 

Females .. 

CO 

CO 

Males 

CO 

cr. 
co"^ 

:      1 

ci 

CD 
CC 

o 

p 

o 

C«-| 

O 
o 

1 

c 
J 

a 
J 

■j 

< 

9 

3 
■i 

I      r- 

'.  c 

C 

E 

I 

:  2 

:  ~^ 

:  S 

:  o 

:  p 

:>  o 

c 

:  ^ 

I   c 

.    a 

1  E- 

o 
:  a 

S  cr 
) 

r 

3    ;: 
I   I 

^     ? 

:  fl 
:  o 

I  a  i 

Ml 

:i  o  c 

I  Pi 

>      1 
:      1 

1 

> 

2 
2 

5 

3      . 

I 

251 


ENGLAND. 
Table  3 — Continued. 


• 

Males. 

Females.        Total. 

• 
Proportion  per  cent  of  recoveries  to  admis- 
sions   

30. 

38. 

34. 

Proportion  per  cent  of  recoveries  to  numbers 
treated                  ..           

8.3 

Proportion  per  cent  of  deaths  to  admissions. 

Proportion  per  cent  of  deaths  to  numbers 

treated 

36.5 

29.5 

33. 

8. 

1871. 
Proportion  of  pauper  lunatics  to  total  pau- 
pgpg                     ■*                            

4.63 

Proportion   of  pauper    lunatics  in  asylums 
and  workhouses 

85.43 

Proportion  of  lunatics  maintained  by  rela- 
tives and  others    

14.57 

Fifty-four  English  asylums  made  postmortem  examinations  in  thirteen 
hundred  and  fifty-two  cases,  out  of  thirty-one  hundred  and  thirty -five 
deaths,  in  the  year  eighteen  hundred  and  seventy. 


252 


Table  4. 

Shoiving  the  ratio  of  total  number  of  Lunatics,  Idiots,  etc.,  to  poj)ulation  in 
each  year  from  eighteen  hundred  and  sixty-two  to  eighteen  hundred  and 
seventy-one,  both  inclusive;  also,  number  of  patients  in  private  houses,  and 
number  in  asylums,  ivorkhouses,  etc.  , 


? 

^ 

^ 

Number 

in  private 

Number  in  asylums, 

otal 
oi'luna 
iots,  et 
uary  1 

houses. 

poorhouses,  etc. 

YEAR. 

o 

num 

tics, 

st... 

» 

^ 
p 

? 

hj 

:  ^  ^•cr' 

O  o 

P 

^ 

P 

^ 

i 

i  1'  'i"'^ 

? 

9 

^ 

1862 

20,336,467 

41,129 

2.02 

146 

6,157' 

5,274 

29,552 

1863 

20,554,137 

43,118 

2.09 

153 

6,405 

5,354 

31,206 

1864 

20,772,308 

44,795 

2.15 

159 

6,541 

5,446 

32,649 

1865 

20,990,946 

45,950 

2.18 

212 

6,557 

5,662 

33.519 

1866 

21,210,020 

47,648 

2.24 

227 

6,580 

5.873 

34,968 

1867 

21,429,508 

49,086 

2.29 

223 

6,638 

5,920 

36,305 

1868 

21,649,377 

51,000 

2.35 

274 

6,829 

5,850 

38,047 

1869 

21,869,607 

53,177 

2.43 

324 

6,987 

5,900 

39,966 

1870 

22,090,163 

54,713 

2.47 

356 

7,086 

5,924 

41,347 

1871 

22,704,108 

56,755 

2.49 

392 

7,331 

6,062 

42,970 

253 


ENGLAND. 
Table  5. 

Showing  total  number  of  Paupers  and  of  Pauper  Lunatics,  Idiots,  etc.,  ivith 
the  proj^ortion  per  cent  of  Pauper  Lunatics  to  Paupers,  the  pro2:)ortion  per 

.  thousand  of  Pauper  Lunatics  to  population,  and  proportion  per  one  hundred 
thousand  of  non-Pauper  Lunatics  to  population. 


Total 
paup 
class 
uary 

Total 
paup 
tics,  1 
Janu 

Pore 
p  a  u 
tics, 
paup 

Propo 
1,000 
lunat 
to  po 

YEAR. 

^2  ^  ^ 
^  o  '-^^  5 

p  ^^  -' 

2  9'%"^. 

%:'%% 

rtion 
00  of 
s  not  p 
to   en 
lation. 

p  -.  *^ 

a  ?:r*^'^ 

:  V:.'^  ^-^ 

:  13  :i.o 

:  a  '^  6 

•  <-^  p  0 

r  P  cr  CD 

:  ^  s  :=  ;d 

:  1  1—  .-,5 

:  .  «  1-15 

\    0   ,   ^ 

1862 

946,166 

35,709 

3.77 

1.75 

26.G 

1863 

1,142,624 

37,611 

3.29 

1.8*2 

26.7 

1864 

1,011,753 

39,190 

3.87 

1.88 

26.9 

1865 

974,772 

40,076 

4.11 

1.90 

27.9 

1866 

924,813 

41.548 

4.49 

1.95 

28.7 

1867 

963,200 

42,943 

4.45 

2.00 

28.6 

1868 

1,040,103 

44,876 

4.31 

2.07 

28.3 

1869 

1,046,103 

46,953 

4.48 

2.14 

28.4 

1870 

1,083,532 

48,433 

4.46 

2.19 

28.4 

1871 

1,085,661 

50,301 

4.63 

2.21 

28.4 

From  the  above  we  find  there  is  one  pauper  lunatic  to  every  twenty-two  paupers;  one 
pauper  lunatic  to  every  four  hundred  and  fifty-one  of  the  population,  and  one  non-pauper 
lunatic  to  every  three  thousand  five  hundred  and  eighteen  of  the  population. 


254 


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256 


ENGLAND. 

Table  8. 

Showing  Length  of  Residence  in  Sixteen  English  Asylums  of  Patients  icho 
Died  therein  or  icere  Discharged  therefrom  Recovered  in  1870. 


DIED. 

Discharged  Eecovered. 

LENGTH   OF   RESIDENCE. 
• 

P 

3 

t. 
S 

p 

«2 

o 

3 
p^ 

g 

• 

\ 

Under  1  month 

52 
67 
56 
69 
76 
212 

32 
43 
31 
29 
52 
235 

84 

110 

87 

98 

128 

447 

15 
92 

105 
97 
52 

38 

10 

81 

182 

139 

53 

54 

25 

Over  1  and  under  3  months ... 
Over  3  and  under  6  months  . . . 
Over  6  and  under  12  months... 

Over  1  and  under  2  years 

Two  years  and  over 

173 
287 
236 
105 
92 

Totals 

532 

422 

954 

399 

519 

918 

Tabl 

E    9. 

Showing  Proportion  per  cent  of  Kiimhers  Died  and  Discharged  Recovered  in 
the  folloiBing  periods  to  the  whole  Number  Died  and  Discharged  Recovered. 


Under  1  month 

8.80 
11.53 

9.11 
10.27 
13.42 
46.86 

2.72 

18.84 
31.26 
25.70 
11.43 
10.02 

0"v^r  1  and  under  3  months 

^ 

Over  3  and^nder  6  months 

>^  !^ 78.55 

Over  6  and  under  12  months 

Over  1  and  under    2  years 

11}  21.5 

Two  years  and  over 

Total 

100.00 

257 

ENGLAND. 

Table    10. 

Showing  Numbers  Resident,  Admitted,  Treated,  Discharged,  Died,  and  Re- 
maining; also  Proportion  per  cent  of  Recoveries  and  of  Deaths  to  Admis- 
sions for  Ten  Years,  1861-1870. 


1 

^  ^ 

^ 

£  O  •-! 

c  - 

3-«=o 

►^.o 

^Q^ 

o^ 

PATIENTS. 

Numbers. 

if 

.     go- 

0 

per 
reat 

C  o 

C    o 

CO  3 

1      c^ 

•     n- 

Numbers  resident  January  1st,  1861 

Admitted 

24,989     ... 

101,927     ... 

Treated  

126  916     ... 

Discharged  cured 

34,716 

34.05 

27.3 

Discharged  not  cured 

22,826     ... 

Died 

32  087 

1 

Total  discharged  and  died 

89,629     ... 

Remaining 

37,287     ... 

1 

i 

SCOTLAND. 

Table  11. 

Showing  nmnher  of  Patients  resident,  number  treated,  admisMons,  recoveries, 
and  deaths,  icith  proportion  of  the  recoveries  and  of  the  deaths  to  the  admis- 
sions and  to  the  number  treated  in  the  Lunatic  Asylums  visited  in  the  year 
eighteen  hundred  and  seventy-one. 


ASYLUMS. 


tz; 


^ 


Proport'n  pr  j  Proport'n  pr 
centum  of  i  centum  of 
recover'sto  •     deaths  to 


I        r^- 


rf^ 


Eoyal  Edinburgh. 
Fife  and  Kinross.. 

Dundee  Eoyal 

Inverness  District. 

Stirling  District 

Glasgow  Koyal 


Total. 


754 

227 
190 
279 


545 


1,995 


265  I 
70  I 
59  ! 

58  i 
252  i 
32G  I 


1,019 
297 
249 
337 

252 
871 


118 
35 
25 
26 
14 

147 


44.52 
50.00 
42.37 
44.82 
5.55 
45.09 


1,030       3025 


365      206       35.05 


25.28 
18.57 
22.03 
7.71 
6.34 
21.77 


12.06 


11.57 
11.78 
10.04 
44.82 
5.55 
16.87 


20.03 


6.57 
4.37 
5.22 
7.71 
6.34 
8.15 


6.80 


33 


258 


P 
< 

O 

o 


H 


g 

^ 
^ 


r-i  CO  -^  (M 

T— 1 

T— f 

O 

1 

Ci  lO  -t^  -*  t>-  -*  C5       .       .       .       . 

Total 

C0rHOC0f0iO(MCiOi0:0 

< 

lO  Oq^CO^                     O  ^  ^  =^^ 

t-  00  o  t-    : 

'M 

O 

O  t-  CO  o      • 

CO      ■ 

H 

Females 

1-1  T-i  (M  Tt^    : 

M 

^ 

irTT-TTtT       : 

^ 

" 

o 

Males 

-f<  in  ci  ia> 

OD  t^  la  L- 
t^  Cl  l--  c^ 

Ci 

CO  t-  1^5  CO 

c: 

(M  t-  O  -J^ 

-f 

Total 

1-  O  -^  'O 

« 

-tTi-TcrT 

(M  CO  iO  lO 

t- 

w 

•tH  CO  -rfi  CO 

co 

Females 

O  O  tH  CO 

<M 

ii^ 

CO  -t^   O   T-H 

'M 

1-1  -1-  CO  CO 

T— 1 

Males 

(M  t-  O  G^ 

!M 

CO  CO  cr.'  CO 

-M 

CO  t-  CO  o 

a 

Total 

i-H^rf   CO^r^ 

w 

T-T    1— r 

lO  lO  o  rM 

o 

Females 

Ci  -7^  -H  O 

O  G^l   GO  rH 

-t 

1         X 

GO  T-^-  Ci  -t^ 

t- 

Males 

CO  CO  C5  Ci 
lO  C^l  t- 

-+ 

:  ^  'd 

:  t^  0  ,^ 

:  .^  ^  0 

CO 

:s-P-3ii 

00 

•    ;:h    J-i  r^   '^ 

1—1 

iJ^?-- 

-i-T 

O    '"    -^    ^    '^ 

00 

CO 

§  2  2  S  J 

3    . 
o    > 

a 

r- 

c 

< 

^0055 
-+-S  -4J  ■+-»  ^  zi 

S||32 

A:5  2 

o 

o 
o 

^      0     0     00     !E 

Issfl 

^  tr.^  o  ^ 

0    Ct_,    C4_    C4_,    q_, 
P       0       0      0       0 

^  1  g^  1  o 

1  -I'i  1  -5 

'-r  d  s  "^  '" 

^-^-^    &§D 

^'0000       1 

^    o  1-^   ;-(    ;-! 

•-  '^  '^  '^  "42       1 

^.t^-2  ^2^-^  o  O  O  O 

^ 

;< 

rHp 

p 

^P 

C: 

?p- 

^P. 

^P^ 

^P- 

^       1 

CO 

!>;  CO  CO  "^^ 
t-  <M  !M 


0 

O     02 


S     S 


^  S  o 


o  .2  ^a  .l::^ 
g"  J  ^  ^ 


o  a  a: 


?^  o 


IT) 

m 

m 

r. 

0 

0 

0 

_^ 

-+-> 

11 

r- 

c5 

rt 

<i> 

j^ 

j2 

ro 

^ 

;=! 

s 

Ct! 

j_, 

^ 

r-i 

0 

(--) 

0 

0 

Ph 

^ 

5^ 

0 

c3 

ci 

0 

C4-I 

C.-I 

C*-( 

<V-I 

0 

0 

0 

0 

^ 

0 

0 

0 

0 

fc/}biD 

-^ 

-(-> 

0 

9 

0 

0 

o" 

;_, 

'^ 

0 

0 

0 

P-i 

PPP 

259 


::s 

■ 

;55:> 

p 

•"-O 

^ 

^ 

O-D 

T— ( 

-< 

^C? 

p 

(J 

P 

rH 

M 
^ 

P^ 

1  ) 

O 

H 

^ 

J2 

CO  CO  fO  >n  rH         O         O)         !» 

SSSigS    ^5    s    g 

Total 

CO  CO  00  r-l  iM        rH        t^        1^ 

-A^'^^      -•     c|     CO 

Females .. 

2 

COrH 

o 

lO  lO  lO  rjH  o       O       O       i^ 

Males 

^J^^cZ^^'S      -•      o      o 

1 

cq 

1 

(MOOfHCiO        O       O        -"ti 

tni 

Total 

OCOrHrHO         ,^-         ^^         <^ 

"§  o 

^'^ 

-o  o  'O  c-1  w      o      o      :3 

^§ 

Females .. 

^i-      -^^1      o      o)-      t^' 

gPH 

^^ 

-^ 

COQOlOt^CO         O         CO        CO 

j;-      «    ^    w    o     i 

1 
1 

Males 

liP^  1  3  3    i 

s 

Total 

^ 

!>i 

■ 

S3 

O  O  ->0  1^  CO        -^        O        GO 

Females .. 

CO;^l^^CO         „.        ^^        ^. 

rH 

1                 '^ 

o 

(MCOOiOO)        '^l        lO        -*< 

1    ^ 

Males 

5^S^^-        ^-        ^-        00 

c' 

<M  lO  l-^  CO  -*       1--        CO       -^ 

g 

Total 

S^'^S-      g      ^5      S 

>-j 

<!^ 

(M  00  Ci  CO  1^        Ci        'i+i       l-~ 

SS"--    3    »    Sj 

Females .. 

_> 

Ph 

O  t-^  00  I^  1^        O        01        i-H 

j:; 

Males 

C^OOICO-H       ,^.       ^.       ^ 

CJ 

"                                       CO          C-l          rH 

H 

O  rH  Ci  rH  '"-O         CO          O          1-^ 

^. 

Total 

^^^^^       CO       ol       00- 

j:^ 

^jTrn" 

'-'  r2 

s^ 

i^  ^ 

c:i  -^  i>-  o  uo      o      rH      CO 

S<1 

Females .. 

J^^^^S      o      g-     «=• 

>  o 

cf                       ' 

O).^ 

OQ^ 

1^  1--  Csl  lO  rH         1-i         O         Ci 

f5 

Males 

.   .    .   .  '^   .  -^   .^   .      1 

.  o   :  o   :  n 

Pi  :  ft  :  cy 
1        1       *"* 

^ 

'-6 

i'S  i^    :  ?^, 

s 

o 

jij  o  o    :  >:! 

Q 

.2:2*^  :  r 

c«    O    t>    CC    t/3    C 

o 

•z;  fH  O  (:::,=:  o 

1 

5  «■ 

cr 

o 
"1? 

S  '^  fS  «  ;::r^ 

o  r-  o  .^  o  j: 

gliliiili|g  1 

« 

Ph 

pfi 

Ph     P^     Ph 

1 

260 


SCOTLAND. 

Table  14. 

The  ratio  per  one  thousand  of  the  total  number  of  Lunatics,  Idiots,  and  persons 
of  \insound  mind,  to  the  ])opidation  in  each  year  from  eighteen  hundred  and 
sixty-tico  to  eighteen  hundred  and  seventy-one,  both  inclusive. 


Population 

Total  number  of 
lunatics,  idiots, 
etc.,  January  1st. 

Kation  per  one 
tliousand  to  pop- 

nlntimi      

Number  in  private 
dwellings 

Number  in  Asylums  and 
Poorhouses. 

TEAR. 

^ 

p 

^ 
^ 

1862 

3,083,989 
3,101,345 
3,118,701 
3,136,957 
3,153,413 
3,170,769 
3,188,125 
3,205,481 
3,222,837 
3,358,613 

6,341 
6,327 
6,359 
6,468 
6,616 
6,762 
6,931 
7,157 
7,409 
7,808 

2.05 
2.04 
2.03 
2.06 
2.09 
2.13 
2.17 
2.23 
2.29 
2.32 

1,741 
1,679 
1,637 
1,609 
1,568 
1,548 
1,521 
1,500 
1,469 
1,430(?) 

1,031 
1,023 
1,018 
1,055 
1,104 
1,143 
1,158 
1,128 
1,163 
1,178 

3,548 
3,604 
8,683 
3,783 
3  922 

1863 

1864 

1865 

1866 

1867 

4,046 
4,224 
4,494 

4,728 
4,817 

1868 

1869 

1870 

1871 

I  to  438 

1  to  2,548 

1  to  2,936 

1  to  697 

1 

261 


^  00 


<^ 

»   Si 

^^ 

o^ 

■^^ 

■*o   ."^ 

SS     5^ 

I5J  ^^ 

^f^ 

^     « 

^5. 

§^ 

■-;s^ 

p 

f^ 

lo      t*s  i:>Q 

<1 

-^   I's. 

^ 

W                 ^      CO 

H 

n          ^<    ?^ 

O 
O 

r-                    CT)     =0 

rf) 

^•"^ 

^  2 

»v     ~* 

^^^q 

53  s^ 

i- 

rN     CU 

"^  Is 

$i  « 

•+W    <:u 

Sfi 

Se, 

S^ 

^^ 

^  g 

1^ 

^^ 

i^ 

•5S^ 

CO    Si 

'i  ^ 

^  2 

-^  s 

^-^^ 

§ 

^ 

•^ 

^ 

o 

o        


Total, 


Female.. 


Male., 


Total. 


Female., 


Male. 


5qff5S     CO 


Total . 


Female., 


Male. 


Total , 


Female.. 


Male. 


Total . 


Female- 


Male. 


Total. 


sf  ccc5 


S?^§^ 


Female.. 


Male.. 


Total. 


Female., 


Male., 


Total , 


Female., 


Male. 


pi  ^ 

OS 

2,145 
347 
509 

38 

CO 

ill        : 

3 

:   :   :       : 

:    :    :        : 

1 

c^'c-Jcq     .-T 

t 

oT 

6,705 
1,667 
1,267 

771 

o 

6.289 
1,231 
1,038 

507 

OJ" 

■  Ti  a  o 
m  a  a 

S  S  ej  3'^ 


26i 


cq      H 


o 
CO 


"&> 


f^.3? 


co" 


Oh 


or. 

'^ 

'-* 

<= 

^ 

r- 

s 

s 

■<»^ 

'^i 

«: 

'^ 

^ 

^ 

■s> 

o 


1  Proportion  per  cent 

o 

CC  b-  00  O  O         C<1 

o 

!      of  deaths  to  num- 

o 

Ci  rH  CO  o  ci        CO 

1> 

j      ber  treatpfl 

i 

J 

1                                       i 

i  Proportion  per  cent  j      -j^ 

rH  o  o  CO  !M_       re 

Ol 

of  deaths  toadmis-  j      ro 

c:  ci  o  c<i  CO       »d 

T-i 

sions i      ^-i 

(M                C^l  O         CO 

C-l 

1 
Proportion  per  cent  of !      ^ 

^^  O  Tf  )lO  CO         CO 

la 

recoveries  to  num-  !      t^ 

-ri^  o  ci  o^i  ci      \d 

oi 

1      ber  treated j      '"' 

T-l                           1—1 

y—i 

i 
Proportion  per  cent  of  i      t- 

C5  (>1  (>1  7^  0^1         CO 

00 

recoveries    to    ad-        o6 

^'  !>:  CO  t-^  T-5         00 

l>^ 

missions |      <^ 

1                                          i 

Tt<  (M  r-i  tH  O         lO 

CO 

i                                          1 

1     -r^.   -,                                   i^ 

-i^  ^  O  Ci  ^          CO 

o 

1     Died :      ^i 

'M         'M  -t  CO 

l^ 

T— ( 

(M 

^                                                       <M 

^  CO  O  -M  O         O 

t- 

Kecovered t- 

cn       ^  o^  CO       ^ 

o 

T— 1                              T— 

^ 

^ 

-*•:  c:  t-  CO  O        t- 

^-s 

Number  treated 22 

'M  O  T-i  ^  'M         CO 

^ 

CO^        lO  CO  CO          T-^ 

CO 

T— ( 

co*^ 

i      o 

»0  rH  (NJ  CO  O         t- 

CO 

Admissions '      '^ 

(M  1— (  O  1— 1  T^           rH 

o 

Tt-         CO  <M 

'      ^ 

O  O)  i^  O  1-1         O 

t- 

Total !      S3 

CTS  Ttl  rH   O  t-           t- 

CO 

00          (M  CO  C^l          r-( 

rt< 

-2 

G^f 

.§ 

I- 

o 

CO  G^l  -t  CO  -h          T:t< 

(M 

On3 

Pemales..;      *^ 

o  CO  o  cr..  c^       o 
»jr:>       rH  0^1 

00 

T— 1 

'b'% 

i 

T— 1 

rO    ^ 

1 

B 

1 

^ 

lO 

CO   CO  rH  -Ttf  t-           O 

lO 

Males i      ^ 

C:  rH  1— 1  O  !■-           rH 

la      1 

CO           T-(  CO  rH           r-^ 

^^    1 

i 

1 

_      i 

:  g 

I      I      I 

"  •  li 

:  2 

!     ^ 

:  ^ 

:'>^ 

-^s 

UH 

.   m 

-M   r— 1 

J-  -^ 

^ 

:  <1 

C3      >^ 

■—I  j^ 

1^ 

■t< 

fll<=2 

^ 

02  T^ 

<^ 

c5  -i^    L>^-^-= 

i 

O 

|S 

,»^     ^    -i-3     CD  ■        . 

S 
% 
< 

^ 

'cj 

1 
1 

)^ 

^  o 

1  '^  ^  P  ?  1^  5 

o        i 

^   i 

1 

sa" 

p 


t-      ^ 


•2 


.si 


263 

Total 


Female. 


Male 


Total 


Pemale.. 


Male 


i     Total 

I 


Female 


Male 


Total 


^ 


Female 


Male .. 


Total 


Female. 


Male 


O  -^  CO  05  CO  i-H 
00  CO  CiO  eo  O 
(M  lO  OvJ  lO  .-(  O 


•^  Oi  Oi  ?0  1— I  (M 
(N  'to  O  -ti  rfl  CO 


«^  'O  rt<  CO  O^  O 
«0  CO  00  O  Oi  lO 
>-•  C5  tH  (M        05 


(N  O  CO  O  CO  O 
CJ  O  lO  lO  iM  CO 
UO  O  ,-(  TtH  .-I  (M 


C^  CO  »0  l^  CM  lO 
O  CO  iCO  Tt^Oi 
COO^        (M        ,-1 


O-l  CO  O  lO  00  CO 
1^  l^  I— I  (M        o 


COCO  O  CO  r-t  kC 
»-*  Oi  00  CO  Oi  00 
Oi  CO  (M  ><*H   Ci 


O00<N 
3H  coco 

C5  CO'<4< 


o 

:^  ; 

tfj     O!  O 

S  3  ^ 


u:"  t>-*5  ^  S  ;3 


ft 


264 


lEELAND. 

Table    18. 

Calculated  Population  of  Ireland  from  1841  to  1871. 


Year. 

Population.   1 

Year. 

Population. 

Y^ear. 

Population. 

=^1841  ' 

8,175.124 

^1851 

6,552,385 

*1861 

5,798,967 

1842 

7.996,219  ' 

1852 

6,472,830 

1862 

5,728,565 

1843 

7,821.253 

1853 

6.394,244 

1863 

5,659,012 

1844 

7.649,920  i 

1854 

6,316,628 

1864 

5,590.312 

1845 

7,482,687  ' 

1855 

6,239,928 

1865 

5,522,437 

1846 

7,318,985 

1856 

6,164,171 

1866 

5,455,387 

1847 

7.158,800 

1857 

6,089.343 

1867 

5,389,161 

1848 

7,002,164 

1858 

6,015,400 

1868 

5.323,736 

1849  , 

6,848.931 

1859 

5,941,947 

1869 

5,259,100 

1850 

6,699,063 

1860 

5.870,226 

1870 

5,195,236 

1 

*  From  census  returns — remaining  years  calculated. 


Table  19. 

Shotving  proportion  of  the  Insane  to  the  total  of  population  of  Ireland  for  the 
years  1848,  1851,  1855,  1856,  and  1861. 


»^ 

^ 

^ 

"^ 

5 

o 

o| 

5cg 

y 

c 

^^ 

►S  ^^ 

r 

1 

|| 

l-sf 

YEAR. 

o 
1—1 

3 

D 

11 
o3 

of  II 

thousa 
tion.... 

P 

» 

ri 

i  P.^ 

a 

IS 

1    1  -S 

1848 

11.678* 

7,002,164 

1  to  600 

17 

1851 

15,098 

6,552.385 

1  to  414 

23 

1855 

13,493 

6.239,928 

1  to  462 

22 

1856 

14,141 

6,164.171 

1  to  435 

23 

1861 

16,749 

5,798.967 

1  to  346 

29 

1870 

17,194 

5,195.336 

1  to  302 

\ 

33 

' 

•^Approximately. 


265 


I  E  E  L  A  N  D . 

Table  20. 

Civil  condition  of  Patients  in  Asylums  of  Ireland  on  the  first  of  December, 
eighteen  hundred  and  seventy. 


CIVIL   CONDITION. 

Males. 

Females. 

Total. 

Sinffle 

3,006 
701 
113 
170 

2,251 

^   747 
310 
162 

5.257 

IVTarripd                

1448 

Widowed 

423 

XJnkiiown 

332 

Total 

3,990 

3,470 

7,460 

Table  21. 

Shoioing  Duration  of  Disease  on  Admission  of  Patients  Discharged  Becovered 
from  the  District  Asylums  for  the  Year  ending  December  31st,  1870. 


Males. 


Females. 


Total. 


Under  three  months 

From  three  to  six  months.... 
From  six  to  twelve  months. 

From  one  to  two  years 

From  two  to  three  years 

From  three  to  four  years.... 

From  four  to  five  years 

From  five  to  six  years 

From  six  to  eight  years 

Eight  years  and  upwards.... 
Not  specified 


Totals 


339 

313 

625 

35 

46 

81 

32 

32 

64 

21 

25 

46 

10 

14 

24 

7 

4 

11 

4 

1 

5 

1 

1 

2 

1 

1 

2 

11 

5 

16 

57 

48 

105 

518 

490 

1,008 

34 


266 


I E  E  L  A  N  D  . 

Table  22. 

Showing  the  number  of  iKitients  in  the  Lunatic  Asylums  of  Ireland,  loith  the 
admissions,  discharges,  deaths  and  escapes,  and  proportion  of  readmissions 
to  admissions  for  the  frst  time. 


FOR  THE   YEAR  EXDIXG  DECEMBEE  31,  1870. 

Males 

g 

^ 

: 

1 

r 

t  ■ 

Number  of  patients  in  Asylums  Dec.  31,  1869 

Number  admitted  for  the  frst  time 

i 

i,'i4i  1  "971" 

224        196 

2,"il2" 
420 

3,788 

3,333 

7,121 

Number  of  readmissions 

Total  admissions 

1,365 
5,153 

1,167 
4,500 

2,532 
9,653 

Total  number  under  treatment 

N  umber  discharged  recovered 

549  1     539 

166  1     110 

61  1       50 

378        330 

9           1 

1,088 

276 

111 

708 

10 

Number  discharged  relieved 

Number  discharged  not  improved 

Died 

Escaped ! 

Total  discharged,  died  and  escaped 

1,163 
3  990 

19.6 

1,030 
3,470 

20.1 

2  193 

Number  remaining  December  31,  1870 

7  460 

Proportion  per  cent  of  readmissions  to  admis- 
sions for  the  first  time 

19  8 

Males. 

Females. 

Total. 

Proportion  per  cent  of  recoveries  to  admissions 

40. 
10.6 
27.7 
7.3 

46. 
11.9 

28.2 
7.3 

43 

Proportion  per  cent  of  recoveries  to  number  treated 

Proportion  per  cent  of  deaths  to  admissions 

Proportion  per  cent  of  deaths  to  number  treated 

11.2 

27.9 

7  3 

Proportion  per  cent  of  pauper  lunatics   in  asylums  and 
workhouses 

55  2 

Proportion  of  Imiatics  maintained  by  relatives  andbthers 

44.8 

267 

IRELAND 
Table  23. 


The  total  number  of  insane  (including  idiots),  December  31st, 
1870,  was 


These  were  distributed  as  follows: 

In  district  asylums 

In  private  asylums 

In  Workhouses 

In  Jails 

In  Lucan,  supported  by  Government 

In  Central  Asylum  for  Criminal  Lunatics. 
At  large 


17,194 


6,655 

638 

2,754 

1 

43 

167 

6,936 


17,194 


Of  this  number  about  nine  thousand  four  hundred  and  ninety-eight 
are  paupers,  supported  in  asylums  or  Workhouses;  and  the  remaining 
seven  thousand  six  hundred  and  ninety-six  are  supported  by  relatives  or 
others  in  asylums  or  elsewhere. 

The  asylums  are: 


Di strict  asylums ^'^ 

Private  licensed  asylums 20 

Asylum  for  criminal  lunatics 1 


Total 


44 


Table     24. 

Numbers  of  Insane  {exclusive  of  Idiots),  December  31st,  1870. 


In  police  districts,  exclusive  of  those  in  asy 

lums.  Jails  or  Workhouses 

In  Union  Workhouses 

In  district  asylums 

In  Jails 

In  private  licensed  asylums 

In  Central  Asylum  for  Criminal  Lunatics... 

Totals 


Males.       Females. 


1,526 

448 

3,440 


281 
117 


1,228 

697 

3,007 

1 

327 

50 


5,812 


5,310 


Total. 


2,754 

1,145 

6,447 

1 

608 
167 


11,122 


268 


^ 

p 

y—i 

M 

W 

O 

1-5 

^ 

< 
H 

H 
m 


o 


'^ 


„"    ^^S^ 


?S^ 

«       T' 


JO     ?2 


p^ 


m 


^•2 


^1 


So 


Proportion  per  cent 
of  deaths  to  num- 
ber treatpfl 

CO  !>;  O)  O             ; 

T-i  b^  o  t>^        : 

T-l               T— 1 

:    :  ^ 
:    :  00 

CO 

1  Proportion  per  cent 
j      of  deaths  to  admis- 
j      sions 

CO  T— 1  T-i  T— 1        : 

i6  o  -in'  o         : 
CO  CO  o  -+         : 

•    '•  -^ 
:    :  -^ 

o 

Proportion  per  cent 
of    recoveries     to 
number  treated 

o  T^  TjH  »if5        : 
i6  T-l  (m'  t>;        : 

T— <  T— 1                      ; 

:    :  o 
:    :  ^ 

CO 

Proportion  per  cent 
of  recoveries  to  ad- 
missions   

t-  ci  CO  T-i        : 
1-:  -Tf^'  c<i  CO        : 

Ti^  TjH  tH  ^          : 

:    :  o 

T-( 

o 

CO 

Deaths 

csi  00  en  (M         : 

'     T— 1 
'.          I    T— ( 

rH 

CO 

1 

1 

Recoverif's 

(M  ci  o  th        : 

CO  tH  T-(  (M 

T-i                : 

:    :  (M 

:    :  ^ 

CO 
(M 

I^umber  Treated 

(M  CO  t-  O 

i-H  CO  o  (M        : 
CM  o^o  CO         : 

: 
•  o 

:  oi 

CO 
CO 

Admissions 

l:-  lO  (M  Cq            ! 

CO  O  CM  O 
CM  T-f 

is 

:  CM 

as 

CO 

■-+3 

Total 

lOOOiOOO        la  -r-i  lO  i:^ 
TJHt-COCO          COOOOOCM 
TH  f-  -^   <M                                    T-I 

t— ( 

en 

<M 

O 

co'^ 

Female.. 

CO  CO 

CO 

00           •      • 

CO        :    : 

CM             •      • 

oo 

CO  Oi 

lO 

CTi 
CO 
CO^ 

T— ( 

Male 

CO  C5  lO 
t-  00  CO 

CO  rt^ 

CO  00  O  CO 

o 

r-l 

r- 

1- 
1- 

r 
hi 

-i 

i 

:  cc 

^.  - 

m   c 

o  o 
o  o 

p-l  p- 

o  o 

WW 

3  : 

o 
o 

h"E. 
O 

w 

CO 

a 
o 

1 

Maison  de  Sante,  dii  Strop  a   Gand. 

(private) 

Hospice  de  Lieo-e 

ci    : 

3    : 

4-i 

o    : 

is 

CO  S 

-§  i 

•S3 

O 

269 


BELGIUM. 
Table  2. 

Charges  in  Belgium  Asylums  Visited. 


First  Class. 

Second  Class. 

Third  Class. 

Fourth  Class 

ASYLUMS. 

Francs 
Per  Week. 

Francs 
Per  Week. 

Francs 
Per  Week. 

Francs 
Per  Week. 

Lieo-e   St   Ans                          -^8  to  7(t 

1 

23  to  28         2  to  15 

6                   5i 



Colony  at  Gheel 

7  to  11 

5.00  centi. 

6.86  centi. 
5.60  centi. 
5.88  centi. 

Asylum  at  Antweri) 

Guislain  Asylum,  Ghent.. 
Female  Asylum,  Ghent... 
Du  Strop  Asylum,  Ghent. 
St.  Julian  Asy.,  Bruges... 

11 
19  to  57 
19  to  57 

7 

1 

7 

2.00  centi. 

1 

Table  3. 

Showing  the  Number  of  Patients  in  Lunatic  Hospitals,  the  Admissions,  Dis- 
charges and  Deaths,  and  the  Per  Cent  of  Recoveries  and  of  Deaths  to 
Admissions,  and  to  Niunher  Treated  for  the  Year  1865. 


2 

g 
^ 

3 

i 

CO 

^NTiiml'^oT*  c\^  "nnfipnfc  .Tnniifirv  1  <;t    ISfin 

2,663 

865 

174 

1,039 

3,702 

2,778 
690 
122 
812 

3,590 

5,441 

1,555 

296 

1,851 

'PrifQl  nnmKoT  f rpnfpfl  rlnTiTio*  t.liP  VPfiV  

7,292 

.325 
126 
239 
341 

317 

99 

160 

254 

642 
225 
399 
595 




^nf  im  "nrn'VT^prl                                                        

Pied                                          ..            



1,031 
2,671 

830 
2,760 

1,861 

l^pmnininor   .Tfinnnr"^7  lit     18r»fi                                  .       



5,431 

1 

270 

BELGIUM. 
Table  3 — Continued. 


Proportion  per  cent  of  recoveries  to  admissions 

Proportion  per  cent  of  recoveries  to  number  treated 

Proportion  per  cent  of  deaths  to  admissions 

Proportion  per  cent  of  deaths  to  number  treated 


31.2 

8.7 

32.8 

9.2 


39.0 


31.2 
7.0 


34.6 

8.8 

32.1 

8.1 


Table    4 . 

Belgium,  1863,  1864,  and  1865 — Fifty-one  Asylums. 


H 

13' 

^ 

H 

-i 

H 

^ 

H 

H 

Is^umber  Resident. 

^     i 

1& 

r^ 

%i 

=  ^ 

^ 

p 

5 

^  5 

^ 

^ 

r^^ 

^ 

C    O 

YEAR. 

^ 
?» 

^ 

f* 

^ 

o 
> 

^  1 

[ 

3 

< 

o 

o  ^ 
P  o 

HIT 

li 

Ho 

r 

: 

o 

t 

'i 

%  1 

o 

i  P 

■    o 

1? 

:    p 

II 

• 

1 

i' 

•        C/3 

•  "^ 

1863 

2,587 

2,583 

5,170 

1,694 

6,864 

1 
605 

373 

320 

35.50 

30.51 

8.81 

7.57 

1864 

2,673 

2,693 

5,366 

1,669 

7,035 

mi 

427 

590 

34.57 

35.35 

8.20 

8.38 

1865 

2,663 

2,778 

5,441 

1,851 

7,292 

642 

624 

395 

34.68 

32.14 

8.80 

8.15 

Total.. 

7,923 

8,054 

15,977 

5,214 

21,191 

1,824    1 

,424    1, 

705 

34.98 

32.70 

8.60 

S.04 

271 

BELGIUM. 

Table    5 . 

Increase  of  Insane  Persons  in  Belgian  Asylums  for  Ten  Years  (1856  to  1865), 

and  Annual  Increase. 


YEARS. 

Number  of 
Insane. 

Increase. 

In  1856 

4  278 

In  1857 

4,431 
4,508 
4,677 
4,882 
5,033 
5,170 
5,366 
5,441 
5,431 

1  :^-\ 

In  1858 

In  1859 : 

169 
205 
151 
1^7 

In  1860 

In  1861 

In  1862 

In  1863 

196 

In  1864 

T'^S 

In  1865 

10  less 

Total  for  ten  years 

49,217 

Annual  increase 

11.5 

' 

]S[umber  of  asylums  in  Belgium 

For  the  reception  of  men 

For  the  reception  of  women 

For  the  reception  of  men  and  women. 

For  pay  and  non-paying 

For  pay  patients  only 

For  jDaupers  only 

Number  of  j)atients  in  all 


51 
17 
17 
17 

27 

16 

8 

5,431 


The  superior  medical  officers  of  the  asylums  in  Belgium  are  paid  in 
proportion  to  the  number  of  i:)atients  under  their  care,  as  follows: 


NUMBER   OF  PATIEXTS. 


Francs. 


In  an  asylum  of    50  patients 

In  an  asylum  of  100  patients 

In  an  asylum  of  150  patients  {  f.^iS'"''''''''' 

In  an  asylum  of  200  to  250  patients  I  Head  Physician 

I  -A.  ssistan  B 

In  an  asylum  of  250  to  300  patients  |  ^1^^^^^^'"'''''' 


1,460 
2,500 
2,500 

700 
2,800 

850 
3,500 
1,200 


272 


CO    o' 


?^ 


JJ      CO 


Ci  0^1  O 

^1 

1 

-2  a 
33s 

N  u  m  b  e  r 
treated 

CO  d  o 

d 

f^rS 

as 

§5 

.rt    OJ 

"S6 

O  00  tH 

T— 1 

a1 

Admissions.... 

lO  O  CO 

i6 

S'^  ■ 

cc  o  -t^ 

-r- 

Ph 

1     -" 

r. 

X  11  m  b  e  r 
treated 

CO  CO  t- 

CO 

o  p 

d  ci  1-: 

1—1 

i>^ 

c  ^ 

'^J^ 

.X  o 

"S  a 

CO  !M  CO 

CO 

P-'^ 

Admissions.... 

d  00  CO 

CO 

P  o 

-^  CO  CO 

CO 

f^ 

1     Deaths 

t-  CC  'M 
^  I-  ^1 

T— I 

!     Recoveries 

-+  (M  Ir- 

lO  O  rH 

1 

CO 

T-i 

CO  CO  o 

o 

Xiimber  treated 

C^l  'M  'M 

O  X  'M 

T— i 

'     Aciniissions 

-+:  '^  ^ 
CO  CO  lO 

T— 1    T-i 

Ol 

1 

CO 

1 

Ci  t-  O 

lO 

1     -| 

Total 

OO  00  'O 

CO  to  -rH 

3 

o 

•^ 

^         1 

1 

T-^  CO  o 

-f       ! 

Females 

c:  t;^  O 

o         1 

|2 

' 

fl 

CO  -H  o 

T-( 

^ 

3Iales 

^  CO 

i 

p 

k4 

1                             >^ 

1                                       02 

<! 

'; 

1^4 

o 

^ 

^ 

- 

<^ 

^ 

"    ^^^ 

?^  o  S 

-. 

.— 1    .       C 

) 

.2  S^ 

5 

o    O    c 

1 

p: 

5^ 

5P 

i 

1 

^1         :|^ 


r^ 

O   ^' 

a 

::& 

■F^ 

732 

^ 

^'' 

s 

?,^ 

K 

■* 

^S 

^' 

^  r, 

;^ 

c; 

y 

^1 

H 

r- 

O  13 

/- 

O   O 

>^ 

(^ 

o 

^  o 

<1 

^ 

o 

c=  a 

O 

c 

o 

Is 

H 

c; 

^  <s 

v.> 

o 

o 

-^ 

'i% 

o 

o 

-1 

o    • 

en 

p  s 

uO 

-M 

tc   o 

. 

i;-^ 

;; 

l^o 

C 

^;^ 

5  >5 

^ 

o  g 

!- 

o  p. 

<n 

•--2 

o 

s  ^ 

ii 

o  o 

t 

ti 

C 

^ 

-^ 

d 

fcr 

1 

cr. 

n-; 

C^ 

-ij 

c 

^- 

-i- 

o 

^ 

'^ 

^ 

rH 

^ 

>- 

1 

s: 

?>. 

1 

§ 

o 

1 

1 

O 

o 

273 

HOLLAND 
Table    7. 


Showing  nmnher  of  Patients  in  Lunatic  Hospitals,  with  Admissions,  Discharges, 
Becoveries,  and  Deaths  for  the  Year. 


^ 

Hi 

Co 

:? 

^ 

s 

^3 

3" 

P 

O 

i 

Xumber  of  patients  January  1st,  1868. 

Admitted  during  the  year.... 

Treated  during  the  year 

Discharged  during  the  year  recovered  . 

Relieved 

Not  improved 

Died 


Total  discharged  and  died 

Number  remaining  January  1st,  1869. 


177 
36 
35 

193 


33 

36 

165 


380 
69 
71 

358 


1,521       1,658 

500         494 

2,021       2,152 


441 
1,580 


437 
1,715 


3,179 

994 
4,173 


878 
3,295 


p 

f 

CD 

p 

P 

o 

: 

• 

Proportion  per  cent  of  recoveries  to  admissions 

Proportion  per  cent  of  recoveries  to  number  treated 

Proportion  per  cent  of  deaths  to  admissions 

Proportion  per  cent  of  deaths  to  number  treated 


55.4 

41.0 

8.7 

9.4 

8.6 

33.8 

9.5 

7.6 

38.2 

9.1 

36.0 

8.5 


Number  of  insane  in  asylums  January  1st,  1868. 

Population  of  Holland  in  1868 

Proportion  of  insane  to  population 


3,179 
3,592,415 
1  in  1,130 


Principal  causes  of  death:    marasmus,   consumption,  apoplexy,   and 
general  paralysis. 


35 


274 

HOLLAJS^D. 
Table     8 . 


ADMITTED. 


AGE. 


Erom  1844  to  1854. 


Erom  1854  to  1804. 


Totals. 


Less  than  ten  years  ... 
Ten  to  twenty  years  .. 
Twenty  to  thirty  year: 
Thirty  to  forty  years  . 
Eorty  to  fiftj^  years.... 
Eifty  to  sixty  years.... 
Sixty  to  seventy  yeai; 
Over  seven tj'-  3-ears.... 


13 
142 
551 
672 
564 
303 
135 

47 


m\ 

480  I 
569  I 
462  i 
382  I 
198  ' 
101 


20 

236 

1,041 

1,241 

1,026 

685 

333 

148 


27 
255 
788 
888 
692 
490 
242 


19 

162 
852 
916 
652 
497 
292 
140 


46 

417 

1,640 

1,804 

1,344 

987 

534 

219 


40 

397 

1,339 

1,560 

1,2.56 

793 

377 

126 


26 

256 

1,-342 

1,485 

1,114 

879 

490 

241 


66 

653 

2,681 

3,045 

2,370 

1,672 

867 

367 


Totals 2,4: 


2,303  •■  4,730  !  3,461  \  3,530     0,991  :  5,J 


5,833    11,721 


Married 

Unmarried 


1,040 

1,387 


927 
1,.376 


1,967     1,334 
2,763  I  2,127 


Total:. 


^427    2,303  I  4,730  |  3,461 


1,274  I  2,608     2,374'    2,201  j    4,.575 
2,256  I  4,383     3,514  |  3,632  j    7,146 


3,5S0    6,991  j  5,888 


5,833 


11,721 


Insane  for  the  first  time... 
Eelapsed  cases 

..    1,985 
..       442 

1,790     3,775 
513        955 

2,762 
699 

2,736 
794 

5,498 
1,493 

4,747 
1,141 

4,526 

1,307 

9,273 

2.448 

Totals 

..    2,427 
1 

2,303     4,730 

3,461 

3,530 

6,991 

5,888 

5,833 

11.721 

TT  PTp  rl  it  firv                       

366  ■     457        823  '■     879  j  1,039     1,918     1,345 
2,061     1,846     3,907     2,582     2,491     5,073  ,  4,643 

1,496 
4,337 

2,741 

"N^ot  hereditary 

8,180 

Totals 

2,427  1  2,303  ,  4,730  '  3,461  [  3,530  ,  6,991     5,888 

5,833 

11,721 

Erom  intemperance 

Not  liom  intemperance 

307 
2,120 

53        360        586 
2,250  '  4,370    2,875 

109 
3,421 

695 
6,296 

893 
4,995 

162      1.055 
5,671      1,066 

Totals     

2,427 

2,303    4,730  ;  3,461 

■             i 

3,530 

6,991 

■5,888 

5,833  ; 11,721 

"\T  nnin            

871 
436 
322 
507 
98 
193 

981 
331 
434 
391 
70 
96 

1,852 
707 
756 
898 
168 
289 

1,554 
"12 
635 
622 
162 
276 

1,574 
221 
883 
554 
99 
199 

3,128 

2,425 

2,555 
552 

1,317 
945 
169 
295 

4,980 

T^rnnnni'iiiifi    .. 

433 
1,518 
1,176 

648 

957 

1,129 

1,200 

Melancholia 

2,274 
2,074 

Trlint.i«!mp     

261        260 
475  !      469 

429 

Epilepsia 

764 

Totals 

2,427 

2,303 

4,730 

3,461 

3,530 

6,991 

5,888 

5,833 

11,721 

275 

HOLLAND. 
Table    8 — (Continued.) 


CUKED. 

AGE. 

From  1844  to  1854. 

From  1854  to  1864. 

Totals. . 

CD 

a' 

f 

1 

o 

Less  than  ten  jeAvs 

Ten  to  twenty  years... 

Twenty  to  thirty  years 

Thirtv  to  fm'tv  vphts 

1 
44 

188 
222 

1 

39 
227 
244 

2 

83 

415 

466 

358 

249 

94 

28 

1 

87 
313 
312 
246 
184 
80 
14 

1 

59 

419 

437 

267 

164 

76 

18 

2 
146 
732 
749 
513 
348 
156 
32 

2 
131 
501 
534 
428 
294 
125 
20 

2 
98 
646 
681 
443 
303 
125 
40 

4 

229 
1,147 
1,215 

Forty  to  tifty  years 

182  !      176 

110  !      139 

45         49 

Q*'       22 

871 

597 

Sixty  to  seventy  years 

250 
60 

Totals 

798 

897 

1,605 

1,237     1,441 

2,678 

2,035 

2,338 

4,373 

393 

405 

407 
490 

800 
895 

533 
704 

614 

827 

> 

1,147        926 
1,531  j  1,109 

1,021 
1,317 

1,947 
2,426 

TTti  m  nvri  pr1 

Totals 

798 

897 

1,695 

1,237 

1,441 

2,678 

2,035 

2,338 

4,373 

Insane  for  the  first  time 
Eelapsed  cases 


Totals 


611 

187 


r98 


640 

257 


897 


1,251 

444 


1,695 


905 
332 


1,237 


997 
444 


1,441 


1,902 
776 


2,678 


1,516 
519 


2,035 


1,637 
701 


2,338 


3,153 
1,220 


4,373 


Hereditary 

Not  Hereditary 


124 
674 


Totals 


798 


164 

733 


897 


288 
1,407 


1,695 


338 
899 


1,237 


437 
1,004 


1,441 


775 
1,903 


2,678 


462 
1,573 


2,035 


601 
1,737 


2,338 


1,063 
3,310 


4,373 


From  Intemperance 

Not  from  intemperance. 


Totals 


135 
663 

21 

876 

156 
1,539 

231 
1,006 

50 
1,391 

281 
2,397 

366 
1,669 

71 

2,267 

798 

897 

1,695 

1,237 

1,441 

2,678 

2,035 

2,338 

Mania 

Monomania.. 
Melancholia 
Dementia  ... 
Idioti^me ...... 

Epilep.sia 

Totals  ... 


425 

515 

940 

782 

818 

1,600 

1,207 

1,333 

154 

135 

289 

84 

79 

163 

238 

214 

132 

198 

330 

260 

442 

702 

392 

()40 

61 

41 

102 

83 

90 

173 

144 

131 

4 

2 

6 

7 

2 

9 

11 

4 

22 

6 

28 

21 

10 

31 

43 

16 

798 

897 

1,695 

1,237 

1,441 

2,678 

2,035 

2,338 

437 
3,936 


4,373 


2,540 
452 

1,0J52 

275 

15 

59 

4,373 


276 

HOLLAND. 

Table     8 — (Continued.) 


DIED 

AGE. 

From  1844  to  1854. 

From  1854  to  1864. 

Totals. 

: 
: 

B 

a' 

^ 

3 
p 

g 

9 

5          p" 
TO            : 

Less  than  ten  years 

Ten  to  twenty  year'^   

2 

28 

107 

216 

2 

7 

4 
34 
107 
211 
204 
204 
213 
•  173 

!                  1 

11  1         9  j         4 

69  !       63  '       41 
290  {     290  ■      111 
519         n24  ;       331 

13 

1 

70 

120 

35 
177 
336 
391 
320 
199 

35 

104 

Twenty  to  thirt}.  years 

183 
308 
317 
261 
146 
81 

467 

855 

Forty  to  fit't3"Vear* 

258 

133 

521 
465 
359 
254 

575 
431 
234 
129 

337 
854 
324 
275 

912 

Fifty  to  sixty  years 

Sixty  to  seventy  years 

170 

88 
48 

150 
111 
102 

785 
558 
404 

Total"? 

917 

"  693  1  1,610 

1 

1,338 

1,150 

2,488 

2,255 

1,843 

4,098 

t 

437 

480 

1 

265  j      702 

428  1      908 

1 

557 

781 

378 
772 

935 
1,553 

994 
1,261 

2,255 

643 
1,200 

1,637 
2,461 

Unmarried 

Totals 

917 

693 

1,610 

1,338 

1,150 

2,488 

1,843 

4,098 

Insane  for  the  first  time 

Kelapsed  cases 

815 
102 

618 
75 

1,433 
177 

1,186 
152 

1,006 
144 

2,192 
296 

2,001 
254 

1,624 
219 

3,625 
473 

Totals 

917 

693 

1,610 

1,338 

1,150 

2,488 

2,255 

1,843 

4,098 

Hereditary 

100 

817 

87 
606 

187 
1,423 

230 
1,108 

252 

998 

482 
2,006 

330 
1,925 

339 
1,504 

669 

Not  hereditary 

3,429 

Totals 

917 

693 

1,610 

1,338 

1,150 

2,488 

2,255 

1,843 

4,098 

From  intemperance  

91 

286 

15 
678 

106 
1,504 

190 
1,148 

31 
1,119 

221 
2,267 

281 
1,974 

46 
1,797 

327 

Not  from  intemperance 

3,771 

Totals 

917 

693 

1,610 

1,338 

1,150 

2,488 

2,255 

1,843 

4,098 

Mania 

Monomania 
Melancholia 
Dementia  ... 

Idiotisme 

Epilepsia 


Totals 


1 

247 

186 

433 

400 

124 

88 

212 

77 

70 

89 

159 

182  1 

358 

245 

603 

414  i 

40 

29 

69 

63 

78 

56 

134 

202 

917 

693 

1,610 

1,338 

348 

748 

647 

536 

77 

154 

201 

165 

200 

382 

252 

289 

368 

782 

772 

613 

42 

105 

103 

71 

115 

317 

280 

171 

1,150 

2,488 

2,255 

1,843 

277 


o 
a 
o 
O 

T 

00 


Eh 


Totals 


Females 


Males. 


Totals.. 


Females 


Males. 


Totals. 


Females 


Males. 


Totals..., 


Females 


Males. 


Totals- 


Females 


Males. 


Totals. 


Females 


Males. 


H 


c^  w  -o  cc  '^  ti  cc  cs  ira  lo 


■      1  i-l  .-ISM 


^  CM  CO  CO  (M 


^Tt^Tt^COCOOOO^-IOrH 

^^■;;tJ'Oooocioutio 


Oq  CO  b-  rH  rH  Ci  t^  (>;  i^  ,-1         o 

^^a\Z]'^'^  i^  !■-  Tj^  lo      in 

CO  T-((M  (M  i-H  tH         O 


CDiOCOOiuDQOl^OCOr-l 
^t^QOOOiO^COTt^CqcO         Ci 


COOOrHCqCOrHOlMTHO 
CO.-ITtiCOt^lOTflCO(Ml^ 


CO  CO  lO  GO  lO  Ol  O  ( 
IC  CO  Ci  1^  O)  O  CO  ( 
Oi  rH  1— (  CD  r-l  I— I 


Tf^COrHGOOOOWrHCOO 
W  O  CO  LO  CI  1-^  CO  <M  rH 
'^  CO  CO  CO 


O  CO'  rtH  O  t^  Cv|  O  !>.  CO  00 

1--COCO(MOOCO(M 

■^  lO  O  CO 


lO  1^  i^  TjH  ,H 


OOOOOCOCiTt^OlCNCOCO 
CO  00  O  CO  lO  TJH  CN|  rH 


OrHLO--t<t^C5CiCO-*lO 
Ci  07  CO  00  >0  r-l  r-{ 
CM  CO  CO  rH 


'S 


'J'  t^  (M  — I  O  Oi  UO  CO  lO  O 
Ci  CM  lO  CO  CO  CO  (M  rH  rH 
CO  T^l  -*  CM 


lOiOCOiOOiCOiOCiC01> 

OrHlO(MCO(MrH 

(M<M(MrH 


Ci0-lOC0OC0O-*(MC0 
GO  rH  C^  CO  CO  rH  rH 
rH  (M  rH  rH 


C   o) 


S  H  v^  «  k;  S  ^ 

O      H      "      Qj     CD      S      ?^ 

s 


p  £  s  x:S  S  ? 


o  ©■ 


o 


S222£gg2go 


278 


HOLLAND. 

Table    9. 


- 

Admitted. 

Cured. 

Died. 

1844 

to 

1854 

1854 

to 

1864 

1844 

to 

1854 

1854 

to 

1864 

1844 

to 

1854 

1854 

to 

1864 

TMarried  

41.6 

58.4 

37.3 
62.7 

39.4 
60.6 

47.2 
52.8 

1 
42.8 
57.2 

45 

55 

42.9 
57.1 

37.3 
62.7 

40.1 

59.9 

Insane  for  the  first  time 

Eelapsed  cases 

100 

79.8 
20.2 

100 

78.6 
21.4 

100 

79.2 
20.8 

100 

73.9 
26.1 

100 

71.2 

28.8 

100 

72.6 
27.4 

100 

89 
11 

100 

88.1 
11.9 

100 

88.6 
11.4 

TToTOrllf  flTV                                    

100 

17.4 
82.6 

100 

27.4 
72.6 

100 

22.4 
77.6 

100 

17 

83 

100 

28.9 
71.1 

100 

22.9 
77.1 

100 

11.6 

88.4 

100 

19.4 

80.6 

100 
15.6 

Not  hereditary 

84.4 

From  intemperance 

Not  from  intemperance 

100 

7.6 
92.4 

100 

9.9 
90.1 

100 

8.8 
91.2 

100 

9.2 

90.8 

100 

10.5 
89.5 

100 

10.3 

89.7 

100 
93.4 

100 

8.9 
91.1 

100 

7.3 

92.7 

100 

39.2 

16.2 

16 

19 
3.5 
6.1 

100 

44.8 

6.2 

21.7 

16.8 

3.7 

6.8 

100 

42 
11.2 

18.8 

18 
3.6 
6.4 

100 

55.3 

17.2 

19.3 

6.1 

0.4 
1.7 

100 

60 
6.1 

25.8 
6.5 
0.4 
1.2 

100 

57.7 

11.7 

22.5 

6.3 

0.4 

1.4 

100 

26.9 
13.1 
10.2 
37.2 
4.3 
8.3 

100 

30.1 
6.2 

15.5 

31.5 
4.1 

12.6 

100 
28.5 

IVTnnnTYifinia 

9.7 

12.9 

34.3 

4.2 

10.4 

100 

100      1  100 

100 

100 

1  100 

1 

100        100 

100 

279 


O 


Ho 


-t-3 

Treated 

OJ 

c 

f-^ 

^s 

^f. 

VP  r^ 

0-- 

Admisions 

8 

Ph 

Ot  CO  T-i 

d  o  06 


o  o 
o 


Treated. 


Admissions. 


Died. 


no    T-l    '^ 
■'^  "^   "^ 


CO  CO  t-; 

id  06  th 


lO  -h  r-H 
(M  CO  CO 


(MOO 
Ci  lO  tO 


Cured. 


Treated 


Admitted. 


CO  c^i  c^i 

lO  CO  T— I 


iO  CO  o 

CC'  o  t- 

Ci  -*  CO 


-t(  lO  GO 
O  GO  00 
(M  .C>0 


Ci  t>;  CO  <>!  \0  '^^  C^l 

^  O  ci  t-^  GO'  ci  -+■ 


00  (M  o  00  t>  iq  o 
CO  id  ci  CO  T-H  i6  o 
CO  -^  CO  CO  r^i  lO  CM 


t-  t-.  ,-H  00  <©  o  o 
c?i  TjH  06  00  CO  CO  CO 


Tt;  t-  CO  0  lO  lO  lO 
rH  ai  -f  -H  c-j  id  CO 

CO  ^  C>0  rti  (M  CO  <M 


Ci  Ci  lO  CO  '-I  O  CO 
00  o  t-  t-  rtn  10  CO 

T-H  (M 


G<]  Ir-  CO  0:1  C5  <M  tH 

t-  CO  CO  CO  Cvl  CO  o 

CO 


(M  t^  lO  CO  T-i  O  CO 
-h  -t^  O  O  00  CO  t- 
t-  GO  CO  O  rH  lO  CO 


Total, 


i-HrHCOO-tCOCOt^CO(X)COOO 
ODrHOOO'TtHCOT— (CDt— lOOD-HO 
t-i— iCOTt^lO  lO'^COCiCO-t^CO 


Females. 


Males . 


la  o 


CO  CO  lO 

CO   -h    rH 

G<l  CO 


GO  CO  lO  O 

O   r-l    !M    O 

OS  (M  (M  CO 


T— I  -H  GO  O  -Tf  O  lO  (M  CO 
CO  1— I  CO  O  Tfl  CO  CO  C5  i— I 
COiOCOrt^iO         (Mt-CO 


s 

o 

o 


O'  uTi  O 
b-  1-1  O 
1-1  (M  00 


c3    C.* 


3   ^ 


II 

Sis 


?3    ^    Ci 


<<  CG  CQ  <;  P  O  O  0*02  <i  <H  02 


C:)  O  G^T  GO  CO  O'  i:^  ^T 

iM  -rJH  Ci  O  OJ  O  kn  ;^ 

(M  -rt^  T-i  1— I  * 


02 


280 


^  o 


^•^ 


o 


Per  cent  of  deaths 
to  number  treated 


Per  cent  of  cures  to 
number  treated... 


Per  cent  of  deaths 
on  admission 


Per  cent  of  cures  on 
admission 


1^ 


S  o 


Total 


Pemah 


Male 


1^ 

^6 


^^ 


^3 


Total 


Pemale.. 


Male 


Total 


Pemah 


Male 


Total 


Female.. 


Male 


Total 


Pemale. 


Male .. 


I     Total 


Pemale. 


Male 


?-l  ^  X  GO  O     •  O  (M  (M  :0  O  Tfi  o 


w  O  Ci  I-  00  iC  Ci  O  QC  l--^  CO  X 

!■-  CM  C-l  CO  T-H  CO  CO  C^  CC  i-l 


i^  cq  X  t^  lO 

O  1^  X   LC   LO 

■-<  l^  X  C^l  X 


■M      -co      •      •      •  1>-     -XOX 

1^    :  o    :    :    :  os    :  oi  x  F- 

»0      •  Cq  rH 


CO  rH  T-H  CO 
X  O  X  CO 


COlOCOiCiJOCOOCOOi— (COLCX 
Tfi  cq  CO  X  ^  Ci  CO  IC  !>^  CO  ^  CC  CO 
1— I  (>«         CO  (M  1—1  1— I  CO 


Ci  O      I  CiO  — IX 

LO  CO    :  CM  CO  CO  r-( 


O  ;5h  t-  lC  07  O  :  1^  O  Ci  O  rH  CO  1--  ^ 
CO  CO  ^  0-1  t-  —I  :  CO  CO  X  O  W  CO  1--  t^ 
O         CO  CO  I— i  lO      •  "^  00  CO  CO 


i-O  (M  t^  CO 

Tt<  :si  .-I  i-H 

C<J         (M  CO 


ic  oio  cq 

X  rhi  CO  --H 
(N         -!*>  CO 


O  O  O  rt^ 
CO  rH  UO  0-1 
COCq  rH 


CO    :  i^  lo  Tt< 


c'fac? 


JP^   c^ 


:  si  b  G  o    . 


281 


ITALY. 
Table    12. 

General  Movement  of  Population  of  Lunatic  Asijlums — 1867. 


Number  of  patients  in  asylums  January  1st,  1867  ... 

Number  of  j^atients  admitted  during  the  year 

Number  of  patients  discharged  during  the  year 

Number  of  patients  died  during  the  year 

Number  of  patients  remaining  December  31st,  1867 

Proportion  per  cent  of  discharges  on  admissions*.... 

Proportion  per  cent  of  deaths  on  admissions 

Proportion  per  cent  of  deaths  on  number  treated.... 


8,191 
4,909 
3,210 
1,504 

8,386 

65 
30 
11 


*  The  discharges  are  all  given  together,  hence  it  is  impossible  to  say  what  proportion 
recovered. 


Table    13, 

Showing  the  Hereditary  Tendency  to  Insanity  among  Patients  Admitted  and 
Cured  during  the  Year  1868,  and  among  those  remaining  January  1st, 
1869,  m  the  Lunatic  Asylum  at  Florence. 


Admitted. 

Cured. 

Kemaining. 

CASES. 

CD* 

5^ 

si 

E 

(—1 

pa 

1 

CD* 

1 

Hereditary  tendency  admitted 

67 
44 
62 

41    i    10S 

28 
18 
26 

17 

24 
16 

45 
42 
42 

80 
104 
142 

2 

102 
110 
167 

182 
214 
309 

2 

Hereditary  tendency  not  admitted.... 
Hereditary  tendency  uncertain; 

55 
45 

99 
107 

Not  proved  insane 

........ 

Tota\ 

173 

141 

314 

72 

57 

129 

328 

379 

707 

36 


282 


^^ 

"K^    to 

"^■s 

^1 

s  ."^^ 

^t2 

<o 

^2 

,  s 

s  s 

O    ^-o 

*42    ^ 

t;  =2 

o^ 

?^, 

^1 

^<    5S 

•■^^ 

S    ^ 

IK.   -^ 

p 

h^! 

^  s^ 

M 

P3 

^  ?i 

Csl 

co-^'^ 

H 

•2s  "ts" 

1— 1 

^  § 

p 

^^ 

^    ^'^    2^>^ 

< 

o  a 

w    -^^ 

J>2         ^        -^5  ^ 

pq       n       S  ^ 

<1      H      "^  ^ 

H 

r>r-^ 

m 

•S  '^ 

^S     S   r^^' 

^ 

^^     ^     S 

<! 

^      2^3 

^ 

^•§  s 

'V* 

-o  CO  i:i 

Ph 

►C>    <XJ  .^ 

p=^ 

S'S  s 

C5 

^^^ 

<^^^ 

H 

-*~r  ^  s 

h-l 

KH 

H 

:^,  o-s 

^  -^  ^ 

p^^'^ 

.^  «  s^ 

^^  S 

L?     '?^     ^ 


Proportion  per  cent 
of  deaths  to  num- 
ber treated 


Proportion  per  cent 
of  deaths   to   ad- 


missions. 


Proportion  per  cent 
of  recoveries  to 
nmnber  treated... 


Proportion  per  cent 
of  recoveries  to 
admissions  


Died 


Cured 


Treated. 


Admitted. 


*t5  CO 

C  a 

.  Pi 
o 


Total. 


Female. 


Male . 


cr  ic  :r_  Tt^  i^_  Tjj  <^. '-;  00  CO      oi 

<:£  id  m'  o"  o  o  CO  ci  ci  •-£  :^  o 


o         x_  r--  I-- 
L-^  Li  Tf'  l-I  cT  : 


C<J  Oi  LC  X  ' 

■rjH  c:  o  cJ ' 


o  -f  r^^  -*  -M  o 


CO  CO 


i^  -M  cc  ri  -M  o 

cr.  -M  -^  o  L-r  CO 
■<*<  CO  i-l  -^        o 


l>-  0-1  lO  01  GO  O 
Ol  1-  Ol  CO  Ol  Ol 


O  O  X  o  -t^  o 

1-  iC  CO  1-  05  — I 

CO  01         CO         CO 


0  o 

C  CO 

01  .-! 


>o||| 


t^  "^  CC  CO 

ci  Tj^  CO  ■'^ 


Ct  Ol 

-to 


X  -+I  .-'  C;  Ol  Ol 

■^  r-i  c»  CO  i-o  00 

o  t-  CO  cq  (M 


Ci  tr;  ci  CO  c:  o 

O    LO  ICl^  Lt   O 

O  O  d  r-t  i-H 


C:  CO  1^  ^  X  C5 

CO  ci  oq  CM  CO  CO 

(M  Ol  1-1 


lilffl    k 


is 

X  c 
HO 


283 


Oi  IC  rf  CO  r- 

1  lo            :<?^ 

:      1 

ri'  rH  ic  GC  -o  CO   1  o             :  co'          o    :       | 

1— 1  rS 

t>.       Ci  >C  '^_  -^ 

ic             :  CO 

00     i 

t^  O  O  (N*  C<j  -^ 

<= 

:  -^ 

d    : 

CO  CO  (M  CO  O- 

CO             ;  >-(           CO    : 

00  ■*  IC  CO  rH 

o: 

:t~^          't    :      1 

oi  ci  co'  CO  t-''  1-- 

X 

•3:, 

00    : 

.  ^ 

(M  »0  tH  i.O  CO  'X 

CO 

1  tH              lO      i 

o  -^'  ic  c<i  T^■  X 

-^ 

:  X 

X    : 

TjiCMCNCN 

OJ 

:  <^ 

CO    : 

<;d  CO  o  Ci  1^  (X 

CO 

fl;; 

0    ; 

eot^ 

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:  "^ 

1-1  t^  O  Ci  cc  t^ 

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CI    i 

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lOC 

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CO    : 

r-l 

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:  r-i"                : 

U5  CO  CC  00  Tt<  't 

'    CO 

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00    ; 

i-t  00  CO  O  QO  t— 

1^    : 

COO^O_,- 

1^    L.t 

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C  It; 

CO     . 

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X 

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CO    ;      1 

1-  r-l  iC  TJ.  X  1- 

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CO  1^  X  ^ 

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LO  t^ 

Ci  cc 

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CO  cc 

oc: 

CO  ^ 

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coc; 

TtH   0 

1-1         CO 

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■rt<  CO               <M  CO 

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284 


Recovered 

Admitted  during  the 
Year 

Number  of  Patients, 
Jan.  1st,  1864 


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285 


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Beference: 

D  C— Douch  Cockg. 
B  S— Barrel  Shower. 
H  S— Head  Shower. 
L  S— Lumbar  Shower. 
S  S— Spinal  Shower. 
0  0— Foot  Pans  fixed. 


Fig.  2. 


Reference: 


B— Ventilating  Pipe 

L— Floor. 

0— Rubber  Gaskets. 


289 


[Appendix  G.] 


^         HS    HS    HS 

Homn  Bath 

6 
O 

Baths 

o 

Pulverising  Both 

Dressing  Room 

Dressing  Boom 

Fool  Biilhs 
00    00    00 

Rni/pn   Pnnm 

Se_.L 

Sent 

*"'"■'"     '"'"'"      1 

00    00    00 
FonI    Dafhs 

J*lan  of  Baths  at  Evreux. 


Plan  of  Water  Closet. 


L^Z^ 


Section  throxigh  I K. 


37 


PWn  of  W»t€r  Cles«t,  Washington. 


290 
[Appendix  G.] 


Fig.  3. 


Kitchen  Boiler  on  pivot,  at  Ville  Evrarcl  Asylum, 


Fig.  4. 


Gas  Lamp  at  Evreux. 


Fig.  5. 


fFal/ 


Ha-ha  Fence  and  Seat  at  the  Darbp  Asylum. 


2»1 


LIST  OF  ASYLUMS  IN  FEANCR. 


WHERE      SITUATED. 


Department. 


Commune. 


Naico  of  Establishment. 


Aisne 

Ain 

Ain 

AUier 

Ardeche 

Ariege 

Aude 

Avejron 

Eous.  du  Ehone. 
Bous.  du  Ehone. 
Bous.  du  Ehone. 

Calvados 

Cantal 

Charente 

Char  en  te  Inf..... 

Cher 

Correze  

CoteD'Or 

Cotes  du  Nord... 
Cotes  du  Nord... 

Doubs 

Eure 

Eure  et  Loir 

Finistere 

Finistere 

Haute-Garonne . 
Haute-Garonne . 

Gers 

Gironde 

Gironde 

Gironde 

Herault 

Herault 

Ille  et  Vilaine.... 
Indre  et  Loire... 

Isere  

Jura 

Jura 

Loir-et-Cher 

Hte.  Loire 

Loire  Inferieure 
Loire  Inferieure 


Laon  (Premontin). 

Bourg 

Bourg 

Yzeure 

Privas  

St.  Lizier 

Limoux 

Eodez 

Marseille 

Aix 

St.  Eemy 

Caen 

Aurillac 

Angouleme 

La  Eochelle 

Bourges 

Mouestier-Merline. 

Dijon 

St.  Brieuc 

Lehon 

Besan^on 

Evreux a 

Chartres 

Quimper 

Morlaix 

Toulouse 

Toulouse 

Auch  

Bordeaux  

Cadillac 

Bouscat 

Montpellier 

Montpellier 

Eennes 

Tours 


Ste.  Egreve. 


Dole 

Dole 

Blois 

Le  Puy. 
jSTantes  . 
Nantes  . 


St.  Lazare. 

Ste.  Madeleine. 

Ste.  Catherine. 

Ste.  Marie  Assompt'n. 

St.  Lizier. 

St.  Joseph  de  Cluny. 

Eodez. 

St.  Pierre. 

La  Trinite. 

St.  Paul. 

Bon  Sauveur. . 

Aurillac. 

Angouleme. 

Lafond. 

Bourges. 

La  Cellette. 

La  Chartreuse. 

St.  Brieuc. 

Sacres  Coeurs. 

Mon.  M.  Guibard. 

Evreux. 

Bonneval. 

St.  Athanase. 

Morlaix. 

La  Grave. 

Mon.  Delage. 

Auch. 

Bordeaux. 

St.  Leonard. 

Cast  el  d'Andorte. 

St.  Charles. 

Pont  St.  Come. 

St.  Meen. 

Tours. 

St.  Eobert. 

Les  Carmes. 

Les  Capucins. 

Blois. 

Montredon. 

St.  Jacques. 

I'Grande  Providence. 


292 


LIST  OF  ASYLUMS  IN  FEA]S"CE— Continued. 


"WHEKE     SITUATED. 


Department. 


Commune. 


Name  of  Establishment. 


Loire  Inferieure.. 

Loiret 

Lot 

Lozere 

Maine  et  Loire... 

Manche 

Manche  

Manche 

Manche 

Marne 

Hte.  Marne 

Mayenne 

Meurthe 

Meurthe 

Meurthe , 

Meuse 

Morbihan 

Moselle , 

Nievre 

Nord 

Nord 

Nord 

Oise 

Orne 

Pas  de  Calais 

Puy  de  Dome 

Puy  de  Dome 

Bas-Pyrenees 

Bas-Ehin  

Phone 

Phone 

Phone 

Phone 

Phone 

Phone 

Phone 

Sarthe 

Savoie 

Seine 

Seine 

Seine 

Seine 

Seine  Infre 

Seine   Infre 

Deux-Sevr©8 


I^antes 

Orleans 

Leyme 

St.  Alban 

Ste.  Gemmes  et  Loire 

Pontorson 

St.  Lo 

Priauville 

Le  Mesnil  Garnier 

Chalon3 

St.  Dizier 

Mayenne 

Laxon  

St.  Nicolas 

Jarville  

Fains 

Yannes 

Gorze 

La  Charite  s.  Loire... 

Lille 

Armentieres 

Marquelle. 

Clernjont 

Alencon  

St.  Tenant 

Clermont-Ferrand  .... 

Piom 

Pau 

Brumath 

Lyon 

Lyon  

I^yon  

Lyon  

Lyon  

Calvere  

Yaugneray 

Le  Mans 

Chambery 

St.  Maurice 

Gentilly 

Paris 

Paris  et  environs 

Pouen 

Sotteville  les  Eouen.. 
Niort 


Mon.  Gouin. 

Orleans. 

Leyme. 

St.  Alban. 

Ste.  Gemmes. 

Pontorson. 

Bon  Sauveur. 

Bon  Sauveur. 

Ancien  Convent. 

Chalons. 

St.  Dizier. 

La  Poche  Gandon. 

Mareville. 

St.  Francois. 

La  Malgrange. 

Fains. 

L'Humanite. 

Depot  Mendicite. 

La  Charite  s.  Loire. 

Lille. 

Armentieres. 

Lommelet. 

Mon.  Labitte. 

Alen9on. 

St.  Yenant. 

Ste.  Marie  Assompt'n. 

Piom. 

Pau. 

Stephansfeld. 

L'Antiquaille. 

St.  Jean  de  Dieu. 

St.  Yincent  Paul. 

Croix  Pousse. 

Champ- Yert. 

St.  Julien. 

Yaugneray. 

Le  Mans. 

Bassens. 

Charenton  (Imperial) 

Bicetre. 

La  Salpetriere. 

Les  13  Asiles  prives. 

St.  Yon. 

Quatre  Mares. 

La  Providence. 


293 


LIST  OF  ASYLUMS  IN  FEANCE— Continued. 


WHERE  SITUATED. 

Name  of  Establishment. 

Department. 

Commune. 

Tarn  

Alby 

Bon  vSauveur. 

Tarn  et  Garonne..    . 

MoHtauban 

St.  Jacques. 
Mont  de  Yerirues. 

Vaucluse 

Avignon 

Yendee 

Napoleon  Yendee 

Poitiers 

Napoleon  Yendee. 
Poitiers. 

Vienne 

Hte.  Yienne 

Limoges 

Limoges. 

Yonne 

Auxerre 

Auxerre. 

[Appendix  H.] 

THE  TWELFTH  A:N"NUAL  COM]!iIEMOEATION 

OF   THE 

OPEXIXG    OF    THE    SUSSEX    LUNATIC    ASYLUX 

WILL   BE   HEL*D 

On  Tuesday,  2Dth  July,  1871. 

Hours — 12  noon — Morning  Prayer,  with  Commemoration  Sermon. 
Preacher,  Ptev.  A.  P.  Perfect,  M.  A.,  Eector  of  St.  John's.  Lewes. 

1-2  p.  M. — Dinner  in  the  Wards  (Eoast  Beef  and  Plum  Pudding). 

1:30  p.  M. — Luncheon  for  the  Visitors  in  the  Eecreation  Hall. 

2-3:30  p.  M. — Games  on  the  Grounds.  Athletic  Sports.  The  Ock- 
enden  Band  will  play. 

3:30  p.  M. — Air.  Basil  Young  will  give  a  Musical  and  Comic  Entertain- 
ment. 

6  p.  M.— Tea. 

7  p.  M. — Patient's  Ball.     To  conclude  at  9  P.  m. 

THE    BALL    FOE    THE    HOUSEHOLD 

WILL   TAKE   PLACE 

On  Thursday,  July  27th,     9  p.  M.-3  a.  m. 
Mr.  Squire's  Brighton  Quadrille  Band  will  play. 
Haywood's  Heath,  July,  1871. 


THE  ASYLUM,   BOOTHAM,   YOEK. 

PROGRAMME   OF   ENTERTAINMENTS.      WINTER   SESSION,    1870-1. 

Thursday,  October  13th,  1870— Ball. 
Saturday,  October  15th — Meeting  of  Singing  Class. 
Thursday,  October  20th — Eeading. 

Saturday,  October  22d — Discussion  Club  Conversazione  and  Meeting 
of  Singing  Class. 


295 

Thursday,  October  27th — Yocal  and  Instrumental  Concert. 

Saturday,  October  29th — Meeting  of  Singing  Class. 

Thursday,  November  3d — Ball. 

Saturday,  November  5th — Meetings  of  Discussion  Club  and  Singing 
Class. 

Thursday,  November  10th— Lecture,  "  Hull  Worthies,"  by  T.  T.  Lam- 
bert, Esq. 

Saturdaj^,  November  12th — Meeting  of  Singing  Class. 

Thursday,  November  17th — Eeading  and  Musical  Entertainment. 

Saturday,  November  19th — Meetings  of  Discussion  Club  and  Singing 
Class. 

Thursday,  November  24th — Vocal  and  Instrumental  Concert. 

Saturday,  November  26th — Meeting  of  Singing  Class. 

Thursday,  December  1st — Ball. 

Saturday,  December  3d — Meetings  of  Discussion  Club  and  Singing 
Class. 

Thursday,  December  8th — Magic  Lantern  Exhibition. 

Saturday,  December  10th — Meeting  of  Singing  Class. 

Thursday,  December  15th — Lecture,  ''A  Yisit  to  a  Coal  Mine,"  by  Dr. 
Procter,  F.C.S. 

Saturday,  December  17th — Meetings  of  Discussion  Club  and  Singing 
Class. 

Thursday,  December  22d — Eeading  and  Musical  Entertainment. 

Friday,  December  23d — Meeting  of  Singing  Class. 

Thursday,  December  29th — Lecture,  "The  History  of  Music,  with 
Illustrations,"  by  the  Rev.  H.  Y.  Palmer. 

Friday,  December  30th — Meetiug  of  Singing  Class. 

Thursday,  January  5th,  1871 — New  Year's  Ball. 

Friday,  January  6th — Second  ditto. 

Saturday,  January  7th — Meeting  of  Singing  Class. 

Thursday,  January  12th — Lecture,  "Thomas  Gent,  an  Old  York 
Printer,"  by  the  E^verend  Canon  Eaine,  M.A.,  Secretary  to  the  Surtees 
Society. 

Saturday,  January  14th — Discussion  Club  Conversazione  and  Meeting 
of  Singing  Class. 

Thursday,  January  19th — Magic  Lantern  Exhibition. 

Saturday,  January  21st — Meeting  of  Singing  Class. 

Thursday,  January  26th — Yocal  and  Instrumental  Concert. 

Saturday,  January  28th — Meetings  of  Discussion  Club  and  Singing 
Class. 

Thursday,  February  2d— Ball. 

Saturday,  February  4th — Meeting  of  Singing  Class. 

Thursday,  February  9th — Lecture,  "  Some  African  Tribes,"  by  Doctor 
Needham. 

Saturday,.  February  11th — Meeting  of  Discussion  Club  and  Singing 
Class. 

Thursday,  February  16th — Lecture,  "Caverns  and  their  Contents," 
by  S.  W.  North,  Esq.,  F.G.S. 

Saturday,  February  18th — Meeting  of  Singing  Class. 

Thursday,  February  23d — Yocal  and  Instrumental  Concert. 

Saturday,  February  25th — Meetings  of  Discussion  Club  and  Singing 
Class. 

Thursday,  March  2d— Ball. 

Saturday,  March  4th — Meeting  of  Singing  Class. 

Thursday,  March  9th — Magic  Lantern  Exhibition. 


296 

Saturday,  Marcli  11th — Meetings  of  Discussion  Club  and  Singing  Class. 

Thursday,  March  16th — Eeading  and  Musical  Entertainment. 

Saturday,  March  18th — Meeting  of  Singing  Class. 

Thursday,  March  23d— Lecture,  "  The  Northwest  Highlands  and  West- 
ern Islands  of  Scotland,"  b}^  the  Eev.  Canon  Hey,  M.A. 

Saturday,  March  25th — Meetings  of  Discussion  Club  and  Singing 
Class. 

Thursday,  March  20th — Yocal  and  Instrumental  Concert. 

Saturday,  April  1st — Meeting  of  Singing  Class. 

Thursday,  April  6th— Ball. 

Saturday,  April  8th — Meetings  of  Discussion  Club  and  Singing  Class. 

Thursday,  April  13th — Eeading. 

Saturday,  April  15th — Meeting  of  Singing  Class. 

Thursdaj^,  April  20th — Lecture,  "An  Analysis  of  the  Franco-Prussian 
AYar,"  by  ^Y.  Wallen,  Esq. 

Saturday,  April  22d — Discussion  Club  Conversazione  and  Meeting  of 
Singing  Class. 

Thursday,  April  27th — Eeading  and  Musical  Entertainment. 

Saturday,  April  29th — Meeting  of  Singing  Class. 

The  lectures  and  readings  commence  at  six  o'clock  p.  m.;  the  discussion 
meetings  at  half-past  six;  the  balls  at  seven;  the  concerts  at  half-past 
seven;  and  the  singing  meetings  at  a  quarter  past  eight. 


NIGHT   ATTENDANTS. 

1.  The  duties  of  night  attendants  shall  commence  at  eight  P.  m.  on 
v^eekdays  and  nine  on  Sundays,  and  cease  at  six  a.  m.,  during  which 
period  they  shall  be  responsible  for  the  condition  of  the  patients. 

2.  They  are  to  obtain  every  night  from  the  attendants  on  duty  in 
each  ward  the  names  of  such  patients  as  require  particular  attention, 
either  on  account  of  their  habits,  fits,  illness,  or  disposition  to  self-injury-, 
and  to  see  that  sufficient  changes  are  provided  for  those  whose  habits 
are  dirty.  Should  they  find  any  patients  wet  or  dirty  when  they  go  on 
duty,  they  must  require  the  day  attendants  in  charge  of  such  patients  to 
attend  to  them  and  hand  them  over  to  the  night  attendants  in  a  clean. 
dry,  and  proper  state;  and  the  night  attendants  must  themselves  deliver 
over  to  the  day  attendants  all  patients  in  a  like  proper  condition. 

3.  They  shall  visit  each  ward  at  least  seven  times  in  the  course  of  the 
night,  and  oftener  if  necessary,  commencing  their  rounds  at  eight,  nine, 
ten,  and  twelve  p.  m.,  and  at  two,  four,  and  half-past  five  a.  m. 

4.  They  shall  administer  any  medicines,  extra  diet,  wine,  etc.,  (which 
may  have  been  ordered  by  the  Superintendent),  at  the  times  appointed; 
but  shall  not  disturb  any  patient  whom  they  may  find  sleeping,  for  the 
purpose  of  administering  either  food  or  medicine.  A  dry  cloth  or  bib 
shall  always  be  used  when  any  patient  has  to  be  fed. 

5.  They  shall  visit  every  epileptic  patient  on  each  round  of  the  wards, 
and  see  that  they  are  so  lying  as  not  to  endanger  life  from  suffocation 
during  an  accession  of  fits.  Should  any  patient  at  any  time  be  found  out 
of  bed  or  lying  on  his  face,  or  with  his  head  oft'  the  pillow,  he  must  be 
put  to  bed,  placed  upon  his  back  or  side,  with  his  head  on  the  pillow,  and 
shirt  neck  unbuttoned. 


297 

6.  They  shall  devote  particular  attention  to  all  supposed  suicidal  cases, 
and  remove  any  articles  by  which  they  might  possibly  injure  themselves. 

7.  They  shall  use  every  exertion  to  improve  the  dirty  patients  in  their 
habits,  by  getting  them  up  at  the  stated  times,  and  by  taking  such 
measures  as  will  tend  to  keep  them  clean.  Whenever  any  bedding  is 
found  wet  or  dirty  it  shall  be  removed  immediately,  and  fresh  clean 
bedding  substituted;  or  if  necessary  the  patient  shall  be  removed  to 
another  room,  and  the  one  previously  occupied  washed  out.  No  patient 
shall  be  allowed  to  remain  in  a  damp  or  dirty  room. 

8.  The  general  quiet  of  the  galleries  must  be  strictly  attended  to,  and 
any  noisy  patient  visited  and  quieted,  or  if  necessary  removed  to  a  room 
where  he  will  not  disturb  the  other  patients.  In  going  round  the  gal- 
leries, the  night  attendants  must  avoid  disturbing  the  patients  as  much 
as  possible;  and  for  this  purjDose  shall  wear  list  shoes,  and  unbolt  and 
shut  the  doors  quietly.  They  must  also  lock  and  secure  the  various 
doors  and  windows  of  water  closets,  etc.,  on  windy  nights,  to  prevent 
rattling. 

9.  They  shall  see  that  the  various  galleries  are  properly  ventilated, 
and  shall  personally  attend  to  any  fires  which  may  require  to  be  kept 
burning  during  the  night. 

10.  In  the  event  of  any  sudden  illness,  accident,  escape,  or  death 
during  the  night,  they  shall  report  the  same  to  the  Superintendent  with 
the  least  possible  delay. 

11.  They  shall  call  the  day  attendants  at  half  past  five  a.  m.,  stating 
to  them  any  peculiarity  which  may  have  occurred  to  their  respective 
patients  during  the  night;  and  before  going  off  duty  shall  fill  up  the 
report  for  the  night,  to  b^  left  in  the  Superintendent's  room. 

12.  On  Thursdays  and  Saturdays  they  shall  be  at  liberty  from  two  to 
eight  p.  M.,  and  on  Sundays  from  two  to  nine  p.  m.;  but  on  other  days 
they  will  be  exj^ected  to  perform  certain  light  duties  in  the  afternoon. 

13.  In  all  their  intercourse  with  the  patients,  they  must  bear  in  mind 
that  they  are  insane,  and  consequently  not  responsible  for  their  actions. 
Should  any  of  them  make  use  of  abusive  language,  or  offer  them  violence, 
they  must  on  no  account  take  it  as  an  insult,  but,  on  the  contrary,  use 
every  endeavor  to  gain  an  influence  over  them  by  firm  yet  kind  and 
attentive  treatment. 


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MISSING  LIST. 


Ward,  No.. 


187 


Articlea. 

Patients. 

Attendants. 

Attendant. 


laundress. 


"When  signed  to  be  given  to  the  Head  Attendant. 


BEOOKWOOD  ASYLUM. 

NEAR   WORKING   STATION,    SURREY. 

Application  for  Situation  of. * 

(To  be  filled  up  in  the  candidate's  own  writing). 

Name  and  age 

Married,  single,  or  widowed * 

Eeligious  persuasion 

Post  address 

Can  you  read  and  write? 

Brought  up  to  any  particular  trade,  or  class  of  work? 

Any  knowledge  of  music,  vocal  or  instrumental? 

Present  occupation 

Name  and  address  of  various  employers,  in  regular  order,  particularly  of 
all  recent  ones;  length  of  time  with  each,  and  cause  of  leaving. 


300 
BEOOKWOOD   ASYLUM. 

BATHS — REGULATIONS    FOR   THE    GUIDANCE   OF   THE   ATTENDANTS. 

1.  Every  patient  to  be  bathed  immediately  after  admission,  and  once 
a  week  afterwards,  unless  exempted  by  medical  order.  Should  there  be 
the  slightest  doubt  as  to  the  advisability  of  bathing  any  patient,  owing 
to  sickness,  feebleness,  or  excitement,  immediate  reference  to  be  made  to 
one  of  the  medical  officers. 

2.  The  name  of  every  patient  not  having  the  customary  bath  to  be 
inserted  in  the  daily  report  sheet. 

3.  In  preparing  a  bath  the  cold  water  is  always  to  be  turned  on  first. 

4.  Before  the  patient  enters  the  bath  the  temperature  is  to  be  ascer- 
tained by  the  thermometer,  and  is  not  to  be  less  than  eighty-eight 
degrees,  nor  above  ninety-eight  degrees.  In  case  of  the  thermometer 
becoming  inefficient  from  injury,  etc.,  all  bathing  operations  to  be  sus- 
pended until  another  be  obtained. 

5.  Not  more  than patients  to  be  bathed  in  the  same  water.     Any 

infringement  of  this  rule  to  be  entered  in  the  daily  report  sheet. 

6.  Under  no  circumstances  whatever  are  two  patients  to  occupy  the  bath 
at  the  same  time. 

7.  During  the  employment  of  the  bath,  the  room  is  never  to  be  left 
without  an  attendant.  At  all  other  times  the  door  is  to  remain  locked, 
and  the  floor  to  be  kept  dry. 

8.  Under  no  pretence  whatever  is  iyhe  patient's  head  to  be  put  under 
water. 

9.  In  the  bath  the  body  of  each  patient  is  to  be  well  cleansed  with 
soap.  After  coming  out  of  the  bath  especial  care  must  be  taken  to  dry 
those  patients  who  are  feeble  and  helpless,  and  to  clothe  them  as  rapidly 
as  possible. 

10.  The  keys  are  never  to  remain  on  the  bath  taps,  nor  are  they  to  be 
employed  by  patients.  When  not  in  use  they  are  to  be  locked  in  the 
attendants'  room. 

11.  Any  marks,  bruises,  wounds,  sores,  local  pain,  evidences  of  disease 
of  any  kind,  complained  of  by  the  patients,  or  noticed  by  the  attendant 
during  any  of  the  bathing  operations,  to  be  immediately  reported  to  one 
of  the  medical  officers,  and  also  to  be  entered  in  the  daily  report  sheet. 

12.  Any  deficiency  in  the  supply  of  warm  water,  soap,  towels,  etc.,  to 
be  entered  in  the  daily  report  sheet. 

13.  The  attendants  are  to  bear  in  mind  that,  except  under  medical 
order,  the  baths  are  to  be  employed  solely  for  the  purposes  of  cleanli- 
ness. 

14.  Neither  the  cold  nor  the  shower  bath  is  ever  to  be  employed, 
except  under  medical  order,  and  then  only  in  presence  of  one  of  the 
officers.  When  not  in  use  the  door  of  the  latter  is  to  remain  locked, 
and  the  key  to  be  kej^t  in  the  dispensary. 

15.  It  is  the  duty  of  the  head  attendant  to  be  present  at  all  baths 
employed  under  medical  order,  and  to  take  care  that  the  duration  does 
not  exceed  the  time  specified  in  such  order.  He  is  also  to  supervise  the 
whole  of  the  ordinary  bathing  operations,  to  ascertain  that  the  rules 
are  rigidly  carried  out,  and  to  report  to  the  Medical  Superintendent 
every  infringement  that  may  come  to  his  knowledge. 

T.  N.  BEUSHFIELD,  M.  D., 
June,  1867.  Medical  Superintendent. 


301 

[Lunati(?8  1.    (16  &  17  Vict.)    Private  Patient.] 
"Order"  for  the  Eeception  of  a  Private  Patient. 

N.  B. — Under  all  circumstances  the  "Order"  and  "Statement"  below 
to  be  filled  up  by  the  patient's  relatives  or  friends. — Sched.  (A)  No.  1, 
Sects.  4,  8. 

I,  the  undersigned,  hereby  request  you  to  receive ,  whom  I  last 

saw  at ,  on  the  (a) day  of ,  18 — ,  a  (b) as  a 

patient  into  your  hospital. 

Subjoined  is  a  statement  respecting  the  said . 

Signed:    Name,  ;  occupation  (if  any)  ;  place  of  abode, 

;   degree  of  relationship  (if  any),  or  other  circumstances  of  con- 


nection with  the  patient. 

Dated  this day  of ,  one  thousand  eight  hundred  and . 

To  the  Superintendent  of  Bethlem  Hospital,  St.  George's.  Eoad,  Lam- 
beth, S. 

"  Statement." 

If  any  particulars  in  this  State?nent  be  not  known,  the  fact  to  he  so  stated. 

Name  of  patient,  with  Christian  name  at  length,  j    Sex  and 

age, ;  Married,  single,  or  widowed, ;  Condition  of  life  and 

l^revious  occupation  (if  any),  ;   Eeligious  persuasion,  as  far  as 

known,  ;  Previous  place  of  abode, ;  Whether  first  attack, 

;  Age  (if  known)  on  first  attack, ;  When  a&d  where  pre- 
viously under  care  and  treatment, ;  Duration  of  existing  attack, 

;  Supposed  cause, ;    Whether  subject  to  epilepsy, ; 

Whether  suicidal, ;  Whether  dangerous  to  others, ;  Whether 

found  lunatic  by  inquisition,  and  date  of  commission  or  order  for  inquisi- 
tion,   ;  Special  circumstances  (if  any)  preventing  the  patient  being 

examined,  before  admission,  separately  by  two  medical  practitioners, 

;  Name  and  address  of  relative  to  whom  notice  of  death  is  to  be 

sent, . 


How  many  previous  attacks  ? ;  Have  any  relatives  of  the  fam- 
ily been  similarly  affected  ? ;  State  in  what  degree  of  relationship, 

;  Has  the  patient  been  of  sober  habits  ? ;  Number  of  chil- 
dren ? ;  Age  of  youngest  ? ;  Degree  of  education  ? . 


Signed:  Name,  (e) ;  occupation  (if  any), ;  place  of  abode, 


Degree  of  relationship  (if  any)  or  other  circumstances  of  connection 
with  the  patient, r. 

(a)   Within  one  month  previous  to  the  date  of  the  order. 

(6)   Lunatic  or  an  idiot,  or  a  person  of  unsound  mind. 

(e)  The  "Statement"  must  be  signed,  but  "where  the  person  signing  the  statement  19 
not  the  person  who  signs  the  order,  the  following  particulars  concerning  the  pergon  signing 
the  statement  are  to  be  added." 


302 
[8  &  9  Vict.,  Cap.  100.    Sec.  slv.] 

N.  B. — Medical  certificates  of  patients'  examination,  and  the  signa- 
tures, are  required  by  tke  above  statute  to  be  dated  within  seven  clear 
days  of  the  patient's  reception.  In  stating  the  residence,  the  number  of 
the  house  must  be  specified  when  there  is  any. 

The  medical  men  signing  the  certificates  must  not  be  in  partnership, 
nor  one  an  assistant  to  the  other. 

By  Order  of  the  Commissioners  in  Lunacy. 

1. — It  is  absolutely  necessary  that  the  medical  men  should  write  their 
certificates  legibly,  so  as  to  aiford  the  opportunity  of  an  exact  copy  be- 
ing made. 

2. — "All  alterations  in  the  original  certificates,  unless  by  the  certify- 
ing medical  man,  invalidate  them;  and  the  initials  of  the  latter  must  be 
placed  to  every  change  or  addition  made." 

3. — "  If  a  registered  medical  man  describes  himself  as  '  a  duly  quali- 
fied registered  practitioner,'  it  is  not  necessary  that  he  should  specify  his 
medical  qualifications  in  full  in  addition." 

Medical  Certificate.— Sched.  (A)  Xo.  2,  Sects.  4,  5,  8,  10,  11,  12,  13. 

1,  the  undersigned, ,  being  («) ,  and  being  in  actual  prac- 
tice as  a  (p) ,  hereby  certify  that  I,  on  the  day  of. , 

18 ,  at  (c)  [here  insert  the  street  and  number  of  house,  if  any,] , 

in  the  County  of ,  separately  from  any  other  medical  practitioner, 

personally  examined  ,  of   {d),  [state  address  and  occupation,  if 

any,]  and  that  the  said is  a  (e) ,  and  a  proper  person  to  be 

taken  charge  of  and  detained  under  care  and  treatment,  and  that  I  have 
formed  this  opinion  upon  the  following  grounds,  viz: 

1.  Facts  indicating  insanity  observed  by  myself  (/)  [some  definite  fact 
or  facts  must  be  specified,] ; 

2.  Other  facts,  if  any,  indicating  insanity  communicated  to  me  by 
others  (g),  [state  the  name  of  the  person  giving  the  information,] . 

Signed:  Name, ;  place  of  abode, ;  dated  this day 

of ,  one  thousand  eight  hundred  and . 

[Here  follows  duplicate  of  above  certificate.] 

_  (a)  Here  set  forth  the  qualification  entitling  the  person  certifying  to  practice  as  a  phy- 
sician, surgeon,  or  apothecary,  ex  gra.;  Fellow  of  the  Koyal  College  of  Physicians  in 
London. 

(6)   Physician,  surgeon,  or  apothecary,  as  the  case  may  be. 

(c)   Here  insert  the  street  and  number  of  the  house,  if  any,  or  other  like  particulars. 

{d)  A.  B.,  of ,  insert  residence  and  profession  or  occupation,  if  an^'-. 

(e)   Lunatic  or  an  idiot,  or  a  person  of  unsound  mind. 

(/)  Here  insert  the  facts.  Some  definite  fact  or  facts  must  be  specified.  Please  to  write 
the  facts  legibly  and  on  the  lines. 

(g)  Here  state  the  information  and  from  whom  received. 


303 


COMPLAINT  AND  COMMITMENT. 


State  of  California,  County  of 


To  Honorable ,  County  Judge  of  said  county.  respect- 
full}'  represents  that  there  is  now  in  said  county  a  person  named , 

who  is  insane,  and  by  reason  of  insanity  dangerous  to  be  at  large,  and 

is  a  proper  subject  for  the  Insane  Asylum;  and  the  said being 

duly  sworn,  deposes  and  says  that  the  foregoing  statement  is  true; 
wherefore  he  prays  that  such  action  may  be  had  as  the  law  requires,  and 
that  the  said may  be  sent  to  the  Asylum  of  California. 

Subscribed  and  sworn  to  before  me,  this day  of A.  D. 

18G     .  . 

The  foregoing  application  having  been  made  to  me,  ,  County 

Judge  of  said  county,  and named  in  said  application,  being  this 

day  brought  before  me  for  examination  on  said  charge  of  insanity,  and 

having  heard   the  testimony  of and witnesses  who  have 

had  frequent  intercourse  with  the  accused  during  the  time  of  the  alleged 

insanity;  and  doctors  and  graduates  in  medicine,  after 

hearing  the  testimony  of  witnesses,  and  after  a  personal  examination  of 
the  accused,  having  made  the  certificate  by  law  required,  and  being  my- 
self satisfied  that  the  said is  insane  and  dangerous  to  be  at  large, 

and  is  not  a  case  of  idiocity,  or  imbecility,  or  simple  feebleness  of  intel- 
lect, or  old  case  of  harmless  dementia,  or  of  any  class  of  old,  incurable, 
and  harmless  insanity,  nor  a  case  of  delirium  tremens;  and  being  further 
satisfied  of  the  truth  of  all  the  matters  set  forth  in  the  said  physician's 

certificate;  I  do  hereby  order  the  said '—  to  be  taken  to  and  placed 

in  the  Insane  Asylum  at  Stockton,  and is  charged  with  the  execu- 
tion of^this  order. 

As  to  the  ability  of  the  said or  his  kindred  to  bear  the  charges 

or  expenses  for  the  time may  remain  in  the  Asylum,  as  well  as  all 

other  matters  pertaming  to interests  or  possessions,  I  find,  after 

diligent  inquiry  the  facts  to  be  as  follows: 

1.  The  said  is  by  possession  of  able  to  pay 

expenses  in  the  Asylum. 

2.  I  have appointed a  guardian  for  the  said and 

directed  a  quarterly  payment  in  advance,  and  a  supply  of  necessary 
clothing,  together  with  the  bond,  to  be  forwarded  to  the  Asylum  with 
the  said as  by  law  required  of  paying  patients. 

3.  The  said has kindred  in  the  degree,  as  by  law  defined, 

who  are  able  to  pay  said  expenses,  and  I  have made  the  assess- 
ment as  by  law  directed  in  cases  of  kindred  able  to  pay. 

4.  There  is due  the  said for and  I  have 

taken  steps  as  by  law  required  to  be  taken  in  such  cases. 

5.  There money  (in own  right)  on  the  person  of  the  said 

and 


Witness  my  hand  this day  of A.  D.  186 


-,  Judge. 


PHYSICIAN  S    CERTIFICATE. 


State  of  California,  County  of 

'     We, and being  sworn,  do  depose  and  say  that  we  are 

graduates  in  medicine;  that  at  the  request  and  in  the  presence  of  Hon. 
,  County  Judge  of  said  County,  we  have  heard  the  testimony,  and 


304 

carefully  examined  the  said in  reference  to  the  chaj-ge  of  insanity, 

and  do  find  that is  insane  and  by  reason  of  insanity  dangerous  to 

be  at  large.  The  facts  in  support  of  this  opinion  (elicited  by  said  exami- 
nation) are  set  forth  in  the  answers  to  the  following  questions  as  nearly 
as  can  be  ascertained: 

QUESTIONS. 

1.  Name? 

2.  Age? 

3.  Nativity? 

4.  Married  or  single? 

5.  If  children,  how  many,  and  the  age  of  the  youngest? 

6.  If  female  and  married,  maiden  name  and  name  of  husband? 

7.  What  State  last  from  and  how  long  in  California? 

8.  What  occupation? 

9.  What  evidence  have  you  of  the  presence  of  insanity? 

10.  Is  there  a  homicidal,  suicidal,  or  incendiary  disposition? 

11.  Is  the  case  a  recent  one,  having  occurred  within  twelve  months 
last  past. 

12.  When  did  this  attack  first  appear? 

13.  Is  this  the  first  attack?     If  not,  when  did  others  occur  and  what 
their  duration? 

14.  Is  the  disease  increasing,  decreasing,  or  stationary? 

15.  Are  there  rational  intervals?     If  so,  do  they  occur  periodically? 

16.  Is  there  any  permanent  hallucination?     If  so,  what  is  it? 

17.  In  what  way  is  the  accused  dangerous  to  be  at  large? 

18.  Is  there  a  disposition  tp  injure  others?     If  so,  is  it  directed  especi- 
ally to  relatives,  and  is  it  from  sudden  passion  or  premeditation  ? 

19.  If  suicidal,  is  the  propensity  noio  active,  and  in  what  way? 

20.  Is  there  a  disposition  to  filthy  habits,  destruction  of  clothing,  fur- 
niture, etc.? 

21.  Any  relations,  including  grand  parents  and  cousins,  been  insane? 

22.  Any  peculiarities  of  temper,  habits,  disposition  or  pursuits,  before 
the  attack — any  predominant  passions  or  religious  impressions? 

23.  Been  intemperate  in  the  use  of  ardent  spirits,   wine,  opium  or 
tobacco  in  any  form? 

24.  Suffered  from  epilqDsy,  suppressed  secretions,  eruptions,  discharges 
or  sores,  or  injured  on  the  head? 

25.  Any  change  in  the  physical  health  since  the  attack? 

26.  The  supposed  cause  of  insanity? 

27.  Of  what  class  of  insanity? 

28.  What  treatment  has  been  pursued,  and  with  what  effect? 

,  M.  D. 

,  M.  D. 

Subscribed  and  sworn  to  before  me,  this day  of A.  D. 

186     .  1 . 


305 
DIETAEY 

OF  THE  INSANE  ASYLUM  OF  THE  STATE  OF  CALIFORNIA,  FOR  EACH  PATIENT. 

Breakfast. 

One  pint  coffee,  or  more,  to  satisfy  appetite;  five  ounces  loaf  l)read; 
one  half  pound  thick  mush,  made  with  corn  meal  or  cracked  wheat,  fla- 
vored with  syrup. 

Dinner. 

One  quart  soup,  made  from  good  fresh  meat  and  beans,  rice  or  fresh 
vegetables;  four  and  one  half  ounces  meat  without  bone;  five  ounces 
loaf  bread;  one  half  pound  potatoes;  beets,  carrots,  miscellaneous  vege- 
tables and  fruits,  grown  on  the  Asylum  grounds,  are  used  when  in 
season. 

Supper. 

One  pint  tea;  five  ounces  loaf  bread;  three  ounces  gingerbread. 

The  attendants  are  instructed  to  furnish  as  much  bread  and  soup 
as  the  patient  may  desire,  except  in  cases  of  dementia  with  morbid 
appetite. 

Patients  employed  on  the  farm  and  garden  have  a  lunch  of  bread  and 
butter  at  ten  o'clock,  a.  m.  and  at  four  o'clock,  p.  m.,  in  addition  to  the 
above. 

The  diet  of  the  sick  is  prescribed  by  their  medical  attendant. 

Different  kinds  ^f  meats  and  fish  are  substituted  for  beef,  and  other 
variations  made  for  a  change  occasionally,  but  not  regularly,  except 
Fridays,  when  fish  is  used  as  far  as  practicable. 


pjch:mond,  keae  Dublin. 

Ordinary  Diet. — Breakfast:  half  pound  of  bread  and  a  pint  of  tea,  or 
eight  ounces  of  stirabout  with  a  pint  of  new  milk.  Dinner:  ten  ounces 
of  bread  to  males,  and  eight  ounces  to  females,  with  half  pound  of  meat  or 
a  British  pint  of  soup.     Supper:  half  pound  of  bread  and  a  j^int  of  cocoa. 

Extra  Diet. — Breakfast,  ordered  by  the  medical  ofiicers,  an  Qgi^.  Din- 
ner: a  pint  of  beer  or  porter,  half  pound  of  chops,  or  half  pint  of  beef 
tea  and  eight  ounces  of  bread.  Supper:  a  British  pint  of  tea  and  eight 
ounces  of  bread. 

Hospital  Diet. — Beef  tea,  chops,  eggs,  wines,  rice,  arrowroot,  etc. 


39 


306 


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Butter, 


Bread. 


Vegetables , 


Meat  stew. 


Mutton  broth. 


Plum  pudding. 


Baked  pie. 


Suet  pudding. 


Uncooked  meat. 


Irish  stew 


Mutton  Broth. 


Suet  pudding  or  pie. 


Uncooked  meat. 


Beer 


Bread  or  dumpling. 


Bread. 


Cocoa , 


Bread. 


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307 
EDINBUEGH  ROYAL  ASYLUM. 

DIET    TABLE. 

Breakfast  for  Males, 

Six  ounces  oatmeal  or  two  pints  of  porridge,  and  three  fourths  pint 
of  skimmed  or  buttermilk,  or  one  fourth  ounce  of  coffee;  one  half 
ounce  of  sugar;  seven  and  a  half  ounces  of  bread,  and  one  fourth  ounce 
of  butter. 

Females. 

Six  ounces  oatmeal  or  one  and  a  half  ounces  of  porridge,  and  three 
fourths  pint  of  skimmed  or  buttermilk,  or  one  fourth  ounce  of  coffee; 
one  half  ounce  of  sugar;  five  ounces  of  bread,  and  one  fourth  ounce  of 
butter. 

Dinner. 

Sunday — Four  ounces  of  rice;  one  third  ounce  of  sugar,  and  one  half 
pint  of  sweet  milk;  seven  and  a  half  ounces  of  bread  for  males,  and  five 
ounces  for  females. 

Monday — Seven  ounces  of  uncooked  meat  boiled  in  broth,  with  two 
ounces  of  barley;  seven  and  a  half  ounces  of  bread,  or  one  and  one 
eighth  pounds  of  potatoes,  for  males,  and  five  ounces  of  bread,  or  one 
and  one  eighth  pounds  of  potatoes  for  females. 

Tuesday — Seven  ounces  of  uncooked  meat,  stewed  or  roasted,  and 
eight  ounces  of  vegetables,  bread,  or  potatoes,  as  on  Monday. 

Wednesday — Broth  made  with  two  ounces  of  meat  boiled  down  in  the 
broth;  eight  ounces  of  dumpling  of  flour,  suet,  and  currants;  bread  or 
potatoes  as  above. 

Thursday — Seven  ounces  of  uncooked  meat  made  into  L-ish  stew; 
bread  or  potatoes  as  above. 

Friday — Pea  soup  made  from  two  ounces  of  meat  and  four  ounces  of 
peas;  bread  or  potatoes  as  above. 

Saturday — Seven  ounces  of  meat  and  broth,  as  on  Monday;  bread  or 
potatoes  as  above. 

Supper  for  Males, 

Six  ounces  of  oatmeal  or  two  pints  of  porridge,  and  three  fourths  pint 
of  skimmed  or  buttermilk,  or  one  eighth  ounce  of  tea;  one  half  ounce 
of  sugar;  seven  and  one  half  ounces  of  bread,  and  one  fourth  ounce  of 
butter. 

Females. 

One  eighth  ounce  of  tea;  half  ounce  of  sugar;  five  ounces  of  bread, 
and  one  fourth  ounce  of  butter. 

Luncheon  for  Workers. 

Bread,  two  and  one  half  ounces;  cheese,  one  ounce;  beer,  one  half 
pint. 


308 


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309 


GENEEAL    EULES 

FOR   THE 

SUEEEY     COUNTY     LUNATIC     ASYLUM, 

AT    BROOKWOOD, 

Pursuant  to  the  fifty-third  section  of  the  Act  16  ayid  17  Vict.  cap.  97. 


COMMITTEE   OF   VISITORS. 

1.  The  Committee  of  Visitors  for  the  time  being,  shall  meet  for  the 
first  time  at  the  asylum  within  a  fortnight  after  their  appointment,  and 
shall  then  (after  electing  a  Chairman),  appoint  five  members  of  the 
Committee  of  Visitors  to  be  a  House  Committee  for  the  purposes  after 
mentioned,  of  whom  three  shall  be  a  quorum.  They  shall  continue 
their  meetings  at  the  asylum  throughout  the  year,  by  adjournment  to 
Buch  times  as  they  shall  consider  most  convenient. 

2.  At  their  first  meeting,  and  afterwards  as  occasion  shall  require, 
they  shall  make  such  appointments  and  perform  such  duties  as  may  be 
necessary  for  carrying  into  full  effect  the  various  Acts  of  Parliament 
relating  to  lunatics  (16  and  17  Yict.  c.  97;  18  and  19  Yict.  c.  105;  25  and 
26  Yict.  c.  111). 

3.  Minutes  of  the  proceedings  of  the  Committee  of  Visitors  shall  be 
kept  and  entered  by  the  Clerk  to  the  Visitors,  and  the  same  shall  be 
read  at  the  following  meeting  and  signed  by  the  Chairman. 

4.  The  Committee  of  Visitors  shall  make,  from  time  to  time,  such 
"regulations  and  orders  "  as  they  shall  see  fit,  not  inconsistent  with  the 
"general  rules"  for  the  time  being,  in  force  for  the  management  and 
conduct  of  the  asylum. 

5.  No  general  rule  for  the  government  of  the  asylum  shall  be  rescinded 
or  altered,  except  at  a  meeting  of  the  Committee  of  Visitors  specially 
convened  for  the  purjDose;  and  no  alteration  in  the  general  rules  shall 
take  effect  until  it  has  received  the  approval  of  one  of  Her  Majesty's 
principal  Secretaries  of  State. 

6.  They  shall  cause  all  moneys  received  from  every  source  to  be  paid 
to  the  account  of  the  asylum  at  the  bank  of  their  Treasurer,  and  they 
shall  make  all  payments  by  checks,  to  be  signed  by  three  of  their  body. 

7.  A  special  meeting  of  the  Committee  of  Visitors  may  be  at  any  time 
convened  in  the  manner  pointed  out  by  the  Act  16  and  17  Vict,  cap  97, 
sect.  25,  notice  being  given  of  the  particular  business  to  be  transacted 
thereat. 

8.  They  shall  in  addition  to  the  report  required  by  the  Act  16  and  17 
Vict.  cap.  97,  sect.  62,  present  at  every  General  Quarter  Sessions  of  the 
Peace  for  the  county  a  summary  of  their  transactions  during  the  preced- 
ing quarter;  and  at  every  Easter  session  they  shall  present  a  report  on 
the  state  and  condition  of  the  asylum,  with  an  audited  account  of  the 
whole  of  their  receipts  and  expenditures  for  the  year  ending  on  the  pre- 
cedin^thirty-first  day  of  December. 


310 

HOUSE    COMMITTEE. 

1.  The  House  Committee  shall  visit  the  asylum  twice  in  the  course  of 
every  calendar  month,  and  their  duties  shall  be  as  follows: 

2.  To  inspect  the  food  and  see  that  all  contracts  are  performed;  also, 
to  see  all  the  patients  and  all  the  wards  and  premises  appropriated  to 
their  use,  and  also  to  inquire  and  examine  as  to  the  convalescence  and 
improvement  of  particular  patients,  and  as  to  the  treatment,  health,  and 
general  condition  of  the  whole  establishment,  and  to  perform  the  general 
duties  imposed  on  them  by  the  Act  16  and  17  Yict.,  cap.  97,  sect.  61. 

3.  To  audit  all  the  accounts  of  the  asylum,  to  superintend  the  farm 
and  garden,  to  examine  all  bills  due  by  the  asylum,  and  recommend  the 
same  when  correct,  for  payment;  to  examine  all  accounts  for  the  main- 
tenance of  patients  and  for  repairs  previous  to  their  being  sent  to  the 
several  parishes  or  to  the  County  Treasurer,  and  to  consider  all  applica- 
tions for  additional  stores  and  for  advances  to  the  Steward  for  current 
expenses  before  they  are  submitted  to  the  Committee  of  Visitors,  and 
also  to  make  orders  for  such  advances,  not  exceeding  one' hundred 
pounds  sterling. 

4.  To  give  orders,  in  all  cases  of  emergency,  for  such  works  to  be  per- 
formed or  such  goods  to  be  provided  as  shall  be  absolutely  necessary  for 
the  service  of  the  asylum,  reporting  such  orders  to  the  Committee  of 
Yisitors  at  their  next  meeting. 

5.  To  keep  a  record  of  all  their  visits  and  proceedings,  and  to  make 
such  reports  or  recommendations  as  they  may  see  fit;  all  of  which  are 
to  be  read  and  confirmed  at  the  next  meeting  of  the  House  Committee 
and  of  the  Committee  of  Visitors,  respectively. 

CLERK    TO    THE    VISITORS. 

1.  There  shall  be  a  Clerk  to  the  visitors,  who  shall  be  considered  the 
law  officer  and  adviser  of  the  Committee  of  Visitors,  and  shall  prepare 
all  contracts  and  legal  documents.  He  shall  convene  and  attend  all 
general  meetings  of  the  Committee  of  Visitors,  and  also  the  meetings  of 
the  House  Committee  when  required,  and  shall  take  minutes  of  all 
orders  and  resolutions,  and  take  such  steps  as  may  be  necessary  for  car- 
rying them  into  effect. 

2.  He  shall  assist  the  visitors  in  their  examinations  of  the  asylum 
books  of  accounts,  the  quarterly  abstract  of  expenditure  or  mainte- 
nance, and  the  accounts  of  the  Treasurer,  and  in  preparing  the  visitors' 
annual  report  for  publication. 

3.  He  shall  furnish  to  the  Superintendent  a  copy  of  all  orders  made 
by  the  committee  relating  to  the  institution  or  its  inmates. 

4.  He  shall  transact  all  the  ordinary  duties  of  Clerk  to  the  visitors  as 
prescribed  by  the  statute,  and  as  may  be  directed  by  the  committee. 

RESIDENT    MEDICAL    SUPERINTENDENT. 

1.  There  shall  be  a  Medical  Superintendent,  who  shall  be  a  physician 
or  surgeon  and  a  registered  medical  practitioner.  He  shall  be  resident 
in  the  asylum,  shalf  give  up  the  whole  of  his  time  to  the  duties  of  his 
office,  and  shall  not  attend  to  or  engage  in  any  professional  or  other 
business  or  employment  except  that  of  the  asylum. 

2.  He  shall  have  paramount  authority  in  the  asylum,  subject  to  that 
of  the  Visitors;  shall  have  control  over  all  the  officers,  attendants,  and 


311 

servants  and  '.hall  superintend  and  direct  their  duties  as  prescribed  bj 
the  reo-uhitions  and  orders  of  the  Committee  of  Visitors.  He  shall  be 
empowered  to  hire,  suspend,  or  discharge  all  attendants  and  servants, 
subject  to  the  approval  and  confirmation  of  the  House  Committee  at 
their  next  meeting,  when  such  hiring,  suspension,  or  dismissal  shall  be 

reported.  ^.  ,         ^    .  ^.     ^  ^  r 

3  He  shall  be  responsible  for  the  condition  of  the  patients,  and  lor 
the'management  of  the  establishment,  and  shall  have  the  full  direction 
of  the  medical,  surgical,  and  moral  treatment  of  the  patients,  and  of  all 
general  arrangements  within  the  asylum. 

4.  Should  any  case  of  difficulty  or  danger  arise,  he  shall  have 
authority  to  call  to  his  aid  in  consultation  any  registered  medical  prac- 
titioner. .         ,      .    T  ^ 

5.  He  shall  visit  the  wards  and  offices  daily,  making  occasional  night 
visits  also,  and  report  to  the  House  Committee  any  serious  irregularities 
which  may  fall  under  his  notice. 

6.  He  shall  examine  every  patient  shortly  after  admission,  and  shall 
cause  proper  entries  relative  thereto  to  be  made  in  the  books  kept  for 
that  purpose.  i  •   ^ 

7.  He  shall  regulate  and  determine  the  diet  of  the  sick  and  mtirm,^ 
and  shall  also  from  time  to  time  examine  and  report  on  the  quality  of 
all  provisions  furnished  for  the  use  of  the  asylum. 

8.  He  shall  regulate  and  determine  the  bedding  and  clothing  of  the 
patients.  , 

9.  In  all  cases  of  fatal  or  dangerous  accident,  or  other  emergency,  he 
shall  immediately  communicate  the  fact  to  the  Chairman  of  the  Com- 
mittee of  Visitors.  .    ,      r.  .u 

10.  He  shall  not  absent  himself  for  more  than  one  night  from  the 
asylum,  without  the  previous  written  consent  of  one  of  the  Committee 
of  Visitors;  nor  for  more  than  one  week,  without  the  sanction  of  the 
Committee  of  Visitors  or  the  House  Committee;  and  on  no  occasion 
shall  he  leave  the  asylum  unless  in  charge  of  the  Assistant  Medical 
Officer,  or  of  some  other  properly  qualified  medical  substitute. 

11.  He  shall  have  power  to  exclude  from  admission  into  the  asylum 
persons  affected  with  cholera,  or  any  disease  or  malady  which  may  be 
considered  cootagious  or  infectious,  and  persons  coming  from  any  dis- 
trict or  place  in  which  any  such  disease  or  malady  may  be  prevalent. 

12.  He  shall  keep  a  journal,  in  which  he  shall  record  the  name  of 
every  attendant  and  servant  whom  he  shall  hire,  suspend,  or  dismiss, 
together  with  the  date  and  cause  of  such  hiring,  suspension,  or  dismis- 
sal. Also  the  name  of  every  patient  fit  to  be  discharged,  or  likely  to  be 
benefited  by  being  allowed  a  period  of  absence  on  trial.  Also  the  case 
of  every  escape,  death,  and  inquest,  with  such  particulars  as  may  be 
necessary  for  the  Committee  of  Visitors  to  be  made  acquainted.  Also 
all  such  other  facts,  observations,  and  suggestions  as  he  shall  deem 
important,  relative  to  the  condition  or  management  of  the  asylum  or 
the  patients  therein.  And  all  such  entries  shall  be  read  as  part  of  the 
proceedings  at  the  next  meeting  of  the  House  Committee,  or  Committee 
of  Visitors,  respectively.  .     . 

13.  He  shall  make  a  yearly  report  of  the  number  of  admissions,  dis- 
charges, and  deaths  during  the  year,  and  shall,  in  the  same  report, 
describe  the  general  condition  of  the  patients,  the  state  and  manage- 
ment of  the  asylum,  and  such  other  matters  as  he  shall  deem  necessary 
or  the  Committee  of  Visitors  may  direct. 


312 

ASSISTANT    MEDICAL    OFFICER. 

1.  There  shall  be  an  Assistant  Medical  Officer,  who  shall  be  a  member 
of  the  Eoyal  College  of  Surgeons  of  London,  Edinburgh,  or  Dublin,  and 
a  Eegistered  Medical  Practitioner.  He  shall  be  nominated  to  the  Com- 
mittee of  Visitors  on  his  api^ointment  by  the  Medical  Superintendent, 
under  whose  control  and  direction  he  shall  perform  his  duties.  He  shall 
be  resident  in  the  asylum  and  shall  give  up  the  whole  of  his  time  to  the 
duties  of  his  office. 

2.  He  shall  not  leave  the  asylum  when  the  Superintendent  is  absent, 
at  which  time  he  is  to  be  held  responsible  for  the  management  of  the 
Institution.  In  his  own  occasional  absence,  he  shall  conform  to  the 
directions  he  may  receive  from  the  Medical  Superintendent,  as  to  its 
duration  and  the  period  of  his  return.  Should,  however,  he  desire  to  be 
avv-ay  from  the  asylum  for  more  than  one  night,  the  written  consent  of 
some  member  of  the  Committee  of  Visitors  must  also  be  obtained. 

3.  He  shall  exercise  a  general  control  over  the  conduct  of  the  attend- 
ants and  servants,  and  immediately  report  any  misconduct,  irregularity, 
or  neglect  of  duty  on  their  part  to  the  Medical  Superintendent. 

4.  He  shall  have  charge  of  the  dispensary,  and  shall  be  responsible 
for  the  safe  and  proper  custody  of  the  drugs,  surgical  instruments,  and 
appliances. 

CHAPLAIN. 

1.  There  shall  be  a  Chaplain,  who  shall  be  a  clergyman  of  the  Church 
of  England,  in  priest's  orders,  and  shall  be  licensed  by  the  bishop  of  the 
diocese.  He  shall  devote  the  whole  of  his  time  to  the  duties  of  his  office, 
and  not  hold  any  other  engagement. 

2.  He  shall  perform  divine  service,  according  to  the  rites  of  the 
Church  of  England,  in  the  chapel  of  the  asylum,  every  Sunday,  Christ- 
mas day  and  Good  Friday,  preaching  short  sermons  on  each  occasion. 

3.  He  shall  administer  the  holy  sacrament  to  such  of  the  officers  and 
servants  as  may  be  desirous  of  receiving  the  same,  at  least  four  times  in 

•  a  year,  and  to  such  of  the  patients  as  he  may  think  advisable,  with  the 
approbation  of  the  Superintendent. 

4.  He  shall  consider  all  the  household  under  his  spiritual  care.  • 

5.  He  shall  attend  daily  at  the  asylum,  and  administer  religious  con- 
solation to  the  patients,  subject  however  to  the  directions  of  the  Com- 
mittee of  Visitors  and  of  the  Medical  Superintendent. 

6.  He  shall  read  morning  praj^ers  daily  at  such  hours  as  the  Commit- 
tee of  Visitors  and  the  Medical  Superintendent  may  direct. 

7.  He  shall,  under  the  general  control  and  with  the  cooperation  of 
the  Medical  Superintendent,  organize  and  direct  the  schools  for  the 
patients  of  both  sexes,  and  also  classes  for  instruction  in  the  Bible  and 
in  singing;  and  shall  take  charge  of  the  library,  and  control  the  issue  of 
books  and  periodicals. 

8.  He  shall  keep  a  daily  journal  in  which  he  shall  enter  the  hours  of 
his  attendance,  and  such  other  particulars  as  it  may  be  desirable  for  the 
Committee  of  Visitors  to  know,  which  jourjial  shall  be  laid  before  the 
Committee  at  every  meeting. 

9.  He  shall  never  absent  himself  from  his  duties  on  any  Sunday,  or 
for  more  than  two  days  during  the  week,  without  leave  in  writing  of 
one  Visitor,  and  on  providing  some  other  clergyman,  to  be  approved  of 
by  such  Visitor,  to  supply  his  place. 


313 

10.  He  shall  present  an  annual  report  to  the  Committee  of  Visitors, 
stating  the  result  of  his  attendance  on  the  patients. 

TREASURER. 

1.  There  shall  he  a  Treasurer,  to  whom  all  monies  shall  be  paid.  He 
shall  keep  accounts  of  all  monies  received  and  paid  by  him  and  make 
them  up  to  the  thirty-first  of  December,  annually,  and  state  the  balance 
(if  an}^)  then  in  his  hands. 

2.  He  shall  give  security  for  a  sum  to  be  named  by  the  Committee  of 
Visitors. 

CLERK   AND   STEWARD. 

1.  There  shall  be  a  Clerk  of  the  Asylum,  who  shall  act  as  Steward. 
He  shall  perform  all  the  duties  of  both  those  offices,  under  the  control 
and  direction  of  the  Medical  Superintendent,  to  whom  he  shall  imme- 
diately report  whatever  he  may  know  to  be  improper  or  contrary  to  the 
rules  in  the  economy  of  the  house  or  conduct  of  the  servants.  He  shall 
be  resident  in  the  asylum  and  shall  give  up  the  whole  of  his  time  to  the 
duties  of  his  office. 

2.  He  shall  make  all  the  necessary  returns  to  the  Commissioners  in 
Lunacy  and  other  authorities,  as  prescribed  by  the  various  Acts  of 
Parliament  relating  to  lunatics. 

3.  He  shall  take  care  of  all  the  books  and  papers  (except  those  relat- 
ing to  medical  duties),  and  of  all  the  stores,  and  shall  be  responsible 
for  the  quality,  quantity,  and  safe  keeping  of  all  the  articles  received. 

4.  He  shall  examine  and  superintend  the  weighing  and  measuring  of 
all  the  goods  and  provisions  furnished  to  the  establishment,  and  imme- 
diately report  to  the  Superintendent  any  failure  in  the  quality  or  quan- 
tity thereof,  and  take  his  instructions  thereon.  He  shall  order  nothing 
except  under  the  signature  of  the  Superintendent,  and  receive  nothing 
into  the  asylum  without  an  invoice,  which  must  be  signed  by  himself 
in  token  of  its  correctness,  and  then  filed. 

5.  He  shall  superintend  the  weighing  and  measuring  out  of  the  pro- 
visions so  as  to  suit  the  diet  tables;  he  shall  take  stock  once  a  quarter 
and  keep  quarterly  accounts  of  all  moneys  received  of  and  paid  to  the 
Treasurer,  and  also  of  all  goods  ordered  and  payments  made  for  the 
same,  in  such  form  as  the  Committee  gf  Visitors  shall  direct. 

6.  He  shall  distinguish  the  building  account  from  the  maintenance 
account,  and  the  accounts  of  the  county  from  those  of  the  unions  and 
parishes;  and  shall  lay  an  abstract  of  the  accounts  before  the  next 
meeting  of  the  House  Committee  and  of  the  Committee  of  Visitors, 
after  the  termination  of  each  quarter,  showing  the  moneys  received  and 
paid  and  the  unions  and  parishes  in  arrear. 

7.  He  shall  keep  all  such  books  of  accounts,  and  in  such  forms  as 
may  be  ordered  from  time  to  time  by  the  Committee  of  Visitors,  so  as 
to  show  the  true  state  of  the  accounts.  These  books  shall  be  kept  in 
his  office  and  be  subject  at  all  times  to  the  inspection  of  any  member  of 
the  committee  and  of  the  Medical  Superintendent,  to  whom  he  shall 
supply  such  financial  and  other  information  as  he  may  from  time  to  time 
require. 

8.  He  shall  conduct  such  correspondence  as  the  Medical  Superintend- 
ent may  direct,  to  whom  he  must  submit  all  letters  received  by  him 

40 


314 

relating  to  the  asylum  and  its  inmates,  all  of  which  letters  are  to  be 
considered  the  property  of  the  institution.  He  shall  keep  copies  of  all 
correspondence,  whether  replies  to  letters  or  otherwise. 

9.  He  shall  keep  inventories  of  all  the  household  goods,  furniture, 
farming  and  artisans'  implements,  of&cial  books,  medical  instruments, 
and  other  property  of  the  institution. 

10.  In  his  occasional  absence  from  the  asylum  he  shall  conform  to  the 
directions  he  may  receive  from  the  Medical  Superintendent  as  to  its 
duration  and  the  period  of  his  return.  Should,  however,  he  desire  to 
be  away  from  the  asylum  for  more  than  one  night,  the  consent  of  some 
member  of  the  Committee  of  Visitors  must  be  obtained. 

11.  He  shall  give  satisfactory  security  by  such  sureties  as  the  Com- 
mittee of  Visitors  shall  from  time  to  time  require. 

HOUSEKEEPER. 

1.  There  shall  be  a  housekeeper,  who  shall  perform  her  duties  under 
the  control  and  direction  of  the  Medical  Superintendent,  to  whom  she 
shall  immediately  report  whatever  she  may  know  to  be  improper  or 
contrary  to  the  rules  in  the  economy  of  the  house  or  conduct  of  the 
servants.  She  shall  be  resident  in  the  asylum,  and  shall  give  up  the 
whole  of  her  time  to  the  duties  of  her  oflSce. 

2.  She  shall  have  charge  of  the  entire  kitchen  and  laundry  depart- 
ments, the  officers'  and  servants'  apartments,  and  central  offices,  and  be 
responsible  for  their  cleanliness  and  good  order.  She  shall  use  her 
utmost  endeavors  to  prevent  waste,  and  to  check  any  misapplication 
of  stores. 

3.  She  shall  have  authority  over  the  female  servants,  directing  them 
in  their  several  duties;  and  be  responsible  for  the  safety  and  conduct  of 
all  patients  employed  in  any  of  the  departments  over  which  she  has 
control. 

4.  She  shall  suj^erintend  the  preparation  of  the  meals  for  the  patients, 
officers,  attendants,  and  servants,  and  shall  see  that  the  articles  of  food 
are  properly  cooked,  and  served  with  neatnesi  and  punctuality  at  the 
appointed  hours. 

5.  She  shall  superintend  and  be  responsible  for  the  washing,  airing, 
and  regular  distribution  of  all  articles  sent  to  the  laundry  department. 

6.  She  shall  receive  from  the  steward  once  weekly  all  necessary 
materials  to  be  converted  into  clothing,  bedding,  etc.,  for  the  establish- 
ment. She  shall  cut  out  and  supply  to  the  wards,  through  the  head 
female  attendant,  all  needlework  necessary  for  the  employment  of  the 
patients;  and  when  made,  return  all  the  articles  to  the  steward,  stating 
their  number,  with  a  detailed  account  of  the  conversion  of  the  raw 
material. 

7.  In  her  occasional  absence  from  the  asylum  she  shall  conform  to 
the  directions  she  may  receive  from  the  Medical  Superintendent  as  to 
its  duration  and  the  period  of  her  return.  Should,  however,  she  desire 
to  be  away  from  the  asylum  for  more  than  one  night,  the  written  con- 
sent of  some  member  of  the  Committee  of  Visitors  must  also  be 
obtained. 

HEAD    ATTENDANTS — MALE    AND    FEMALE. 

1.  There  shall  be  a  head  male  and  a  head  female  attendant,  who  shall 
perform  their  duties  under  the  control  and  direction  of  and  as  prescribed 
by  the  Medical  Suj)erintendent,  to  whom  they  shall  immediately  report 


315 

whatever  they  may  know  to  be  improper  or  contrary  to  the  rules  in  the 
economy  of  the  house  or  conduct  of  the  attendants.  They  shall  give 
up  their  whole  time  and  attention  to  the  duties  of  their  oflSce. 

2.  They  shall  instruct  the  attendants  in  the  performance  of  their 
duties,  and  shall  at  all  times  require  the  strictest  obedience  to  any 
orders  which  they  may  give. 

GENERAL   MANAGEMENT. 

1.  The  male  and  female  patients  shall  be  kept  in  separate  wards,  and 
no  male  attendant,  servant,  or  patient  shall  be  allowed  to  enter  the 
female  wards,  nor  any  female  to  enter  the  male  wards,  except  in  dis- 
charge of  their  duty,  or  with  adequate  authority.  In  visiting  the  female 
patients,  the  medical  oflScer  shall  be  accompanied  by  the  head  attendant, 
or  some  other  female  officer,  and  no  male  shall  enter  the  female  wards, 
unless  accompanied  by  a  female  attendant.  Any  male  attendant  or 
servant  found  in  any  portion  of  the  women's  wards,  unless  he  can  give 
a  satisfactory  explanation  for  his  being  there  to  the  Superintendent, 
may  be  immediately  dismissed. 

2.  There  shall  be  such  a  number  of  attendants  as  shall  be  sufficient  for 
the  effective  supervision  of  the  patients,  both  by  day  and  night;  and  no 
ward  shall  at  any  time  be  left  without  at  least  one  attendant. 

3.  During  the  day  the  patients  of  both  sexes  shall  be  employed  as 
much  as  practicable  out  of  doors;  the  men  in  gardening  and  husbandry, 
the  women  in  occupations  suited  to  their  ability;  and  as  a  princij^le  in 
treatment,  endeavors  shall  be  continually  used  to  occupy  the  minds  of 
the  patients,  to  induce  them  to  take  exercise  in  the  open  air,  and  to 
promote  cheerfulness  and  happiness  among  them. 

4.  The  male  patients  shall  be  encouraged  to  follow  their  particular 
callings,  and  to  learn  shoemaking,  tailoring,  and  other  common  useful 
trades.  Needlework,  strawwork,  and  other  suitable  employments  shall 
be  provided  for  the  female  patients.  And  they  shall  be  rewarded  by 
such  indulgences  as  the  Superintendent  may  deem  compatible  with  their 
welfare  and  encouragement. 

5.  An  ample  supply  of  books,  and  cheap  publications  of  a  cheerful 
nature,  in  addition  to  Bibles  and  prayer  books,  shall  be  provided,  and 
replaced  in  case  of  destruction;  and  various  methods  of  in  and  out 
door  amusements  shall  be  placed  at  the  disj)osal  of  the  patients  of  both 
sexes,  and  they  shall  be  encouraged  to  have  frequent  recourse  thereto. 

6.  Ample  and  special  provision  shall  be  made  for  the  effective  watching 
of  the  asylum  and  attention  to  the  patients  during  the  night. 

7.  1^0  patient,  on  any  account  whatever,  shall  be  struck,  or  threat- 
ened, or  vspoken  harshly  to;  and  no  patient  shall  be  placed  in  restraint 
or  seclusion,  or  be  subjected  to  any  bath  (except  for  the  purpose  of 
cleanliness),  except  by  the  authority  of  one  of  the  medical  officers. 

8.  All  the  attendants  shall  be  responsible  for  the  safety,  cleanliness, 
and  general  condition  of  the  patients,  and  for  the  ventilation,  proper 
warmth,  and  good  order  of  theii*  respective  wards. 

9.  No  officers,  excepting  the  Treasurer  and  the  Clerk  to  the  Visitors, 
shall  have  any  occupation  unconnected  with  the  asylum,  nor  shall  they 
have  any  interest,  directly  or  indirectly,  in  any  other  establishment  for 
the  reception  and  treatment  of  lunatic,  imbecile,  or  idiotic  patients. 

10.  No  officer,  attendant,  or  servant  shall,  directly  or  indirectly,  take 
any  fee,  reward,  or  perquisite  of  any  kind  from  any  tradesman,  patient, 
or  other  person,  on  pain  of  immediate  dismissal. 


316 

11.  Eelatives  and  friends  of  patients  shall  be  allowed  to  visit  them 
once  in  every  week,  between  the  hours  of  ten  and  four  o'clock,  and  on 
such  other  days  and  hours  as  the  Superintendent  shall  in  special  cases 
permit;  but  no  visitor  shall  be  permitted  to  see  any  patient  if  the  Super- 
intendent shall  state  in  writing  that  the  visit  will  be  injurious  to  the 
patient  or  otherwise  inexpedient. 

12.  Patients  shall  be  at  liberty  to  hold  private  conversation  with 
those  who  visit  them,  but  no  male  visitor  shall  remain  in  a  room  with  a 
female  patient,  nor  a  female  visitor  with  a  male  patient,  except  in  the 
presence  of  an  attendant  or  other  third  person. 

13.  The  person  of  every  patient  shall  immediately  after  admission  be 
carefully  examined  by  the  head  attendant,  who  shall  at  once  personally 
report  in  writing  to  one  of  the  medical  officers  the  bodily  condition  of 
the  patient,  and  especially  of  any  mark,  bruise,  or  injury  of  any  kind, 
bedsores,  ruptures,  or  the  slightest  symptom  of  disease  or  disorder  of 
any  kind;  and  it  shall  be  the  duty  of  one  of  the  medical  officers,  upon 
receiving  notice  of  the  existence  of  any  injury  or  apparent  bodily  dis- 
order, at  once  himself  to  make  a  personal  examination  of  the  patient; 
and  no  relieving  officer  or  other  person  bringing  a  j^atient  to  the  asylum 
shall  be  allowed  to  leave  the  premises  until  such  report  or  examination 
shall  have  been  made. 

14.  All  parish  officers  shall  be  encouraged  to  visit  the  patients  be- 
longing to  their  union  or  parish  once  in  every  three  months,  or  oftener, 
on  a  week  day;  and  to  make  particular  inquiries  from  time  to  time  as  to 
the  treatment  experienced  by  the  patients,  and  their  fitness  for  dis- 
charge. 

15.  [N'otice  shall  be  given  to  the  nearest  relative  in  the  case  of  serious 
illness  to  any  patient,  and  especially  where  a  fatal  termination  is  autici- 
pated.  On  the  death  of  a  patient,  notice  shall  be  immediately  given  to 
the  coroner  of  the  district,  the  parish  officers,  the  registrar  of  the  dis- 
trict, and  the  nearest  relations  of  the  deceased  (if  their  address  be 
known),  and  the  body  shall  be  delivered  to  the  latter  if  requested.  If 
the  body  be  not  removed  early  on  the  fourth  day  after  death,  it  shall 
be  buried  under  the  direction  of  the  Superintendent,  who  shall  have 
power  to  order  an  earlier  interment,  if  from  any  particular  circumstance 
he  shall  consider  such  to  be  necessary. 

16.  Such  patients  as  the  Superintendent  may  direct  shall  in  such 
number  and  at  such  times  as  he  may  think  fit,  be  allowed,  under  proper 
care,  to  take  walks  or  excursions  beyond  the  grounds  of  the  asylum; 
and  he  shall  also  be  empowered,  at  his  discretion,  to  permit  patients  to 
spend  the  day  with  their  friends. 

Approved. 

(Signed)  GATHOPtNE  HAEDY. 

Whitehall,  28th  October,  1867. 


317 


PEOPOSED  CASE  BOOK— (ENGLISH). 
Name.  Admitted. 

Age  and  Sex.  State  as  to  Marriage. 


"Where  from. 


Occupation. 

Mstory: 


Education. 
Eeligion. 


{Previous  attacks. 
Hereditary  history. 
Predisposing. 
Exciting. 

Duration  of  Disease. 

First       f  Mental. 
Symptoms.   |  Bodily. 

Recent     \^^^^[ 
Symptoms.  U^-.^^l^i^ 


Where  treated. 
Disposition    and     habits     in 
health. 


Dangerous. 


Other  facts. 

State  on  Admission. 

'  Exaltation. 

Depression. 

Excitement. 

Enfeeblement. 

IND. 

Memory. 
Coherence. 

Can  answer  questions. 
Delusions. 
^  Other  abnormalities. 

■  Appearance. 

Color  of  hair. 

Color  of  eyes. 

Muscularity. 

Fatness. 

Nervous  system. 

Eeflex  action. 

Pupils. 

Special  senses. 

Eetina. 

ODY.               -l 

Lungs. 

Heart. 

Pulse. 

Other  .organs. 

Tongue. 

Appetite. 

Urine,  specific  gravity. 

Urinary  deposits 

Menstruation. 

Temperature. 

.Hight. 

Weight, 

Name  of  Disease. 


General  Bodily  State. 


318 


Date. 


Temperature. 

Pu 

Ise. 

Weight 

Morn'g 

Even'g 

Morn'g 

Even'g 

Progress  of  Case. 


[Memoranda  to  be  put  in  beginning  of  Case  Book.] 
HISTOEY. 


Previous  Attacks. 
Hereditary  History. 

Predisposing  Causes. 


Exciting  and  Proximate 
Causes. 


Number,  character  of  each. 

Age  of  parents,  relationship  of  parents  or 
grand  parents,  health  of  same,  family  dis- 
eases or  peculiarities — consumption,  epilepsy, 
drunkenness. 

Drunkenness,  overwork,  character  of  vocation 
or  habits.  Food,  tobacco,  tea,  infantile  dis- 
eases, adult  diseases.  Catamenial  irregular- 
ities, marriage,  children,  difficult  labors,  mis- 
carriages, lactation,  etc. 

Disease  of  brain  emotions — blows  on  the  head, 
drinking  bouts,  fever,  poisons,  over-sexual 
excitement,  childbirth. 


STATE  ON  ADMISSION  MOEE  FULLY  AND  SYSTEMATICALLY 

AEEANGED. 


. — Bodily  Condition. 

a,  Hight. 

b,  Weight. 

c,  Temperature. 

d,  Color  of  hair  (baldness). 

e,   Muscularity. 

/,   Fatness. 

g,  Expression  of  face  and  general  appearance 

h,  Any  special  injuries  or  wounds  to  be  noted 

*. — Vegetative  Func- 

a, Digestive — Tongue,  stomach,  appetite,  con 

tions. 

dition  of  bowels. 

b,  Dermic — Conditions  as  to  moistness,  erup- 

tions, and  other  abnormalities. 

c,  Circulatory — Pulse,  cardiac  murmurs,  flush- 

ing of  face,  or  inject  of  conjunctiva. 


C. — Eeproductive  Fung. 

TIONS. 


319 

d,  Eespiratory— State  of  lungs,  breath,  rapid- 

ity of  respiration. 

e,  Glandular — Exam,   of  urine,  state  of  liver, 

spleen,  thyroid,  etc. 


a, 


X). — Nervous  System.        a, 


b, 


Abnorm.  of  penis  or  testes  in  men — mas- 
turbation, syphilis,  etc. 

In  women — Catamenia,  discharges,  syphili, 
pregnancy,  nursing,  etc. 

Paralysis,  epilepsy,  catalepsy,  hysteria,  and 
other  abnormalities  unconnected  with  the 
special  senses  or  mental  functions. 

Special  senses — 


1.- 


-Sight — a, 
b, 
c, 
d, 

e, 
A 
9^ 


Color  of  iris. 

Shape  and  size  of  pupils. 

Condition  of  retina. 

Vision. 

Knowledge  of  color. 

Hallucinations. 

Illusions. 


2.- 


-Hearing — a,  External  ear. 

b,  Deafness. 

c.  Hallucinations. 


d,  Illusions. 


3. — Smell — a,  Any  abnormality  of  nose. 


Sense  of  smell. 
Hallucinations. 
Illusions. 


4. — Taste — a,  Sense  of. 

b,  Hallucinations. 

c,  Illusions. 

5. — Touch  and  Nervous  Sensibility — 

a,  Sense  of  pain. 

b,  Eeflex  action. 

c,  Hypersesthesia. 

d,  Illusions  and  hallucinations,  in- 

cluding those   of  internal   or- 
gans. 


J7. — Mental   Symptoms, 

unconnected  with  the 
special  senses. 


a,  Apparent  consciousness. 


Identity. 

Attention. 

Coherence  of  language. 

Memory — a  for  recent  events,  b    for   past 

ditto. 
Exaltation  or  depression  of  spirits. 
Excitement  of  manner. 


320 


A,  Habits  and  propensities  (filthy,  dangerous, 
suicidal,  destructive,  indecent,  etc.) 

i,   As  to  sleep. 

j,  Delusions— not  being  hallucinations  or  illu- 
sions. 

A*,  Other  abnormalities. 


NOYA  SCOTIA   CASE  BOOK. 

Eegistered  Xo.  Previous  :N"o3. 

^N'ame 

Admitted — 
"Where  from 
Brought  by 
Order  of 
Maintenance 
Certificates 

Age  last  birthday 

Sex  state  as  to  marriage 

Occupation 
I^atural  disposition 
Habits  in  health 
Education 
Eeligion 
Address  of  nearest  friend 


HISTORY. 


Age  at  first  attack 
First      I  Bodily 
Symptoms  J  Mental 
No.     and    duration  J 
of  previous  attacks  | 
Where  treated 

f  Hereditary  history 
Causation  -j  Predisposing 

(  Exciting 
Duration  of  present  attack 

Becent    )  Bodily 
Symptoms  ]  Mental 
Suicidal,  and  how 
Dangerous,  and  how 
Other  facts 


321 


Name, 


Date. 


Temperature. 


Morn'g    EA-en's 


Pulse. 


[Weight 


Morn'g    Even's 


Progress  of  Case. 


MICHIGAN  ASYLUM  FOE  THE  INSANE. 


SITUATION. 

The  Michigan  Asylum  for  the  Insane  is  situated  at  KaLamazoo,  upon 
the  Michigan  Central  Eailroaci.  The  location  is  probaby  as  central  and 
convenient  as  any  that  could  have  been  chosen,  having  reference  both 
to  the  present  means  of  communication  with  the  various  parts  of  the 
State,  and  to  any  other  routes  of  travel  likely  to  be  projected  hereafter. 
The  site  selected  for  the  building  is  upon  an  irregular  eminence,  about 
one  mile  from  the  village,  and  sufficiently  elevated  above  the  valley  of 
the  Kalamazoo  Eiver  to  secure  an  extensive  prospect,  and  yet  is  well 
sheltered  and  easy  of  access  from  the  plain  below.  The  location  is  in 
every  respect  healthful  and  desirable,  and  well  adapted  to  the  purposes 
and  objects  of  an  institution  for  the  treatment  of  mental  diseases. 

/ARM. 

The  amount  of  land  originally  purchased  for  the  use  of  the  asylum 
was  one  hundred  and  sixty  acres,  but  to  secure  a  more  desirable  site 
for  the  buildings,  an  adjacent  tract  was  subsequently  added,  making  the 
whole  amount  of  land  in  the  possession  of  the  institution  one  hundred 
and  sixty-eight  acres  (167  7G-100).  Most  of  the  land  is  finely  timbered 
with  the  original  growth  of  oak,  hickory,  and  other  trees,  aifording 
every  facility  which  could  be  desired  for  beautifying  the  grounds.  That 
in  the  rear  of  the  building  is  broken,  and  falls,  by  a  series  of  ravines 
covered  with  trees,  about  eighty  feet  to  the  valley  below,  through 
which  flows  a  small  but  rapid  stream  of  pure  water.  The  buildings 
themselves  will  cover  an  area  of  one  and  one  third  acres.  It  is  designed 
to  preserve  about  fifty  acres  in  groves  and  woodland,  with  walks  and 
drives,  and  the  remainder  will  be  devoted  to  ordinary  agricultural  pur- 
poses. 

41 


322 

GENERAL   PLAN. 

The  ground  plan  was  furnished  by  Doctor  John  P.  Gray,  the  accom- 
plished Superintendent  of  the  New  York  State  Lunatic  Asylum  at  Utica, 
under  whose  directions  the  work  was  commenced.  It  might  here  be 
remarked  that  the  principles  laid  down  in  a  series  of  propositions  rela- 
tive to  the  construction  and  arrangement  of  hospitals  for  the  insane, 
unanimously  adopted  by  the  "  Association  of  Medical  Superintendents  of 
American  Institutions  lor  the  Insane,"  have  been  fully  carried  out  in  the 
plans  adopted  by  the  Board.  The  form  and  internal  arrangements  of 
the  institution  will  be  readily  understood  by  reference  to  the  accom- 
panying ground  plan.  The  asylum  building  proper,  the  main  front  of 
which  has  an  easterl}--  aspect,  consists  of  a  centre  and  six  wings.  The 
centre  portion  of  the  main  building  is  divided  by  the  entrance  hall  into 
two  nearly  equal  parts.  That  to  the  right  contains,  in  front,  the  princi- 
pal oince  of  the  institution,  the  apothecary  shop,  and  an  anteroom  com- 
municating by  a  private  stairway  with  the  Superintendent's  apartments 
above,  and  in  the  rear  the  matron's  room  and  ladies'  reception  room; 
while  that  to  the  left  contains,  in  front,  the  public  parlor  and  officers' 
dining  room,  and  immediately  behind  these  the  steward's  office  and 
men's  reception  room.  The  second  floor  is  appropriated  exclusively  to 
the  use  of  the  Medical  Superintendent.  Upon  the  third  floor  are  the 
apartments  of  the  Assistant  Phj^sicians,  steward,  and  matron.  The  base- 
ment contains  the  laboratory  connected  with  the  apothecary  shop,  and 
the  officers'  kitchen  and  storerooms.  Immediately  behind  the  centre 
building  is  the  chapel,  aTid  stiil  further  in  the  rear  the  engine  and  boiler 
house.  Extending  from  the  centre  building  tovrard  the  south  for  males, 
and  toward  the  north  for  females,  are  the  several  wards  of  the  institu- 
tion, nine  on  each  side,  including  the  infirmaries. 

MATERIALS. 

The  material  used  in  construction  is  brick,  covered  with  Eoman  cement, 
and  sand,  and  finished  to  represent  freestone.  The  window  caps,  sills, 
and  brackets,  belt  courses,  and  capitals  in  front,  are  of  white  lim.estone 
from  the  Athens  quarries,  near  Chicago.  The  division  walls  throughout 
are  of  brick.  The  xVsylum  is  built  upon  a  system  of  fireproof  construc- 
tion, nearly  all  the  flood's  being  laid  upon  brick  arches  sprung  from  iron 
girders,  which,  beside  providing  against  fire,  give  additional  security  to 
the  building  and  insure  its  durability. 

ARCHITECTURE. 

The  plans  selected  by  the  Board  of  Trustees  were  placed  in  the  hands 
of  A.  H.  Jordan,  architcci,  of  Detroit,  for  the  necessary  elevations, 
details,  etc.  The  style  adopted  is  the  Italian,  it  being  the  lightest,  most 
cheerful,  and  least  expensive  for  the  eflect  required  in  such  an  extensive 
range  of  buildings. 

REFERENCES    TO    THE   PLATE. 

(A)  public  parlor;  (B)  general  office;  (C)  Matron's  room;  (D)  Stew- 
ard's office;  (E  E")  receinion  rooms;  (F)  officers'  dining  room;  (G) 
apothecary  shop;  (H)  anteroom,  communicating  by  a  private  stairway 
with  the  Superintendent's  apartments  above;  (I)  Steward's  storeroom; 


323 


(J  J)  matron's  storerooms;  (K)  associated  dormitories;  (L)  attendants' 
rooms;  (M)  ihi}^  and  recreation  rooms;  (N)  parlors;  (O)  dining  rooms; 
,(U)  chapel,  having  below  it  the  kitchen  and  storerooms;  (1)  boiler 
house;  (2)  engine  and  fanrooms;  (3)  laundry;  (4)  drying  room;  (5) 
ironing  room;  ^(6)  work  shops;  (7  7  7)  covered  corridors. 

APPROPRIATION    OF    WARDS. 

The  various  wards  in  the  institution  are  appropriated  as  follows: 


Nos. 


1  and  2 
3  and  4 
5  and  G 

7 

8 

9 


Classification. 


Number  of  bedi 


No.  of 
ward^. 


Convalescent  and  quiet 

Less  disturbed 

More  disturbed 

Demented 

Demented  and  infirm 

Acute  cases,  etc.,  (Infirmaries) 

Total 


18 


Single 
rooms. 


Associated 
dorm  it's. 


80 
56 
60 
20 
12 
12 


16 
32 


240 


96 
88 
60 
20 
12 
12 


288 


The  divisions  for  the  sexes  are  equal.  Eight  of  these  wards,  inclusive 
of  the  infirmaries,  are  upon  the  first  fioor,  six  upon  the  second,  and  four 
upon  the  third  floor  of  the  transverse  wings.  It  is  considered  that  by 
means  of  these  any  desirable  classification  of  patients  may  be  carried 
out. 

ARRANGEMENT    OF   WARDS. 

Each  ward  has  the  usual  arrangement  of  corridor,  sleeping  rooms, 
day  rooms,  and  dining  room,  with  two  stairways,  a  clothes  room,  lava- 
tory, bath  room,  water  closet,  soiled  clothes  shaft,  drying  shaft,  and  dust 
flue  to  each.  The  corridors  in  the  first,  second,  and  third  wings  are, 
respectively,  one  hundred  and  fifty-five,  one  hundred  and  sixty,  and  sev- 
enty feet  long,  and  in  the  third  stories  of  the  first  and  second  transverse 
wings,  one  hundred  and  nineteen  and  thirty-four  feet  long.  They  are 
uniformly  twelve  feet  wide,  and,  in  common  with  all  other  roOms,  sixteen 
feet  in  height  upon  the  first  and  third  floors,  and  fifteen  upon  the  second. 
The  dimensions  of  the  single  sleeping  rooms  are  eight  and  ten  by  eleven 
feet,  with  an  average  cubic  capacity  of  fourteen  hundred  feet.  The 
associated  dormitories  are  fourteen  by  twenty-one  feet,  and  the  parlors  or 
recreation  rooms,  eighteen  by  twenty.  Lateral  recesses,  extending  into 
the  projecting  towers  in  front,  form  additional  da}'  rooms  in  the  first 
and  second  wmgs  on  either  side.  The  dining  rooms  are  sufticiently  capa- 
cious to  accommodate  the  number  for  which  they  are  intended,  and  are 
supplied  with  detached  sinks,  cupboards,  and  dumb  waiters.  ^  The  clos- 
ets, bath  rooms,  lavatories,  and  clothes  rooms  open  upon  an  adjacent  and 
not  upon  the  main  hall,  giving  a  very  desirable  privacy.  The  bath  and 
closet  fixtures  are  of  approved  construction,  and,  to  prevent  all  possible 


324 

danger  from  leakage,  the  service  pipes  are  conveyed  in  a  separate  pipe 
shailt — an  arrangement  which  also  facilitates  and  cheapens  any  repairs 
that  may  become  necessary.  Drying  shafts,  having  lattice-Vork  floors 
and  communicating  direct}}^  with  the  ventilating  cupolas,  furnish  a  ready  ' 
means  of  drying  mops,  wet  cloths,  damp  brooms,  etc.,  and  thus  mate- 
rially assist  in  promoting  the  cleanliness  and  healthfuluess  of  the  cor- 
ridors. To  prevent  exposure,  the  bathrooms  and  lavatories  have 
communicating  doors,  in  order  that  the  latter  may  serve,  on  "  bathing 
days,"  as  dressing  rooms  to  the  former. 

INFIRMARIES. 

In  a  detached  building,  in  the  rear  of  the  first  transverse  wings,  but 
connected  with  the  wards  by  means  of  a  covered  corridor,  an  infirmary 
is  provided  for  each  sex.  Fitted  up  with  every  convenience,  they  provide 
a  very  desirable  place  for  the  treatment  of  acute  cases,  of  those  who 
are  seriously  ill,  or  of  any  requiring  special  care  and  Irequent  medical 
attention.  They  can  be  reached  at  all  hours  of  the  night  without  dis- 
turbing any  other  portion  of  the  house;  they  provide  the  means  of  isola- 
tion in  case  of  the  occurrence  of  any  infectious  or  contagious  diseases 
in  the  institution,  and  give  to  the  friends  of  dying  patients  an  oppor- 
tunity of  administering  to  them  in  their  last  moments. 

WINDOWS. 

The  windows  are  fitted  throughout  with  a  castiron  sash,  the  upper 
half  of  which  alone  is  glazed.  Posterior  to  the  lower  half,  and  immedi- 
ately against  it  is  a  wooden  sash  of  corresponding  size  and  shape,  moving 
free  and  suspended  by  a  cord  and  weight;  the  former  being  attached  to 
the  bottom  of  the  sash  and  passing  over  a  pulley  near  its  top,  is  always 
entirely  concealed.  The  panes  of  glass  are  six  b}^  nine  inches  in  size.^ 
The  windows,  where  deemed  desirable,  are  protected  by  a  shutter  of 
framed  wicker  w^ork,  sliding  into  the  wall  and  retained  there,  as  also  in. 
its  position,  by  one  and  the  same  lock. 

FLOORING. 

The  floors  in  all  uncarpeted  rooms  are  formed  of  one  and  one  half 
inch  oak  plank,  grooved  and  tongued,  and  none  of  them  being  more 
than  three  and  one  half  inches  in  width.  The  sleepers  and  the  iron 
girders  supporting  the  arches  rest  upon  an  offset  in  the  wall,  which, 
when  finished,  also  forms  the  cornice  in  the  room  below. 

PROVISION    AGAINST    FIRF. 

The  horrible  sacrifice  of  human  life  on  the  occasion  of  the  burning  of 
an  institution  for  the  insane  in  one  of  the  eastern  States,  and  the  pecu- 
liar liability  of  these  buildings  to  take  fire,  as  shown  by  the  frequent 
occurrence  of  such  accidents,  determined  the  Board  of  Trustees,  although 
it  would  somewhat  increase  the  price  of  construction,  to  make  the  asylum 
fireproof.  The  more  recent  partial  destruction  by  fire  of  another  insti- 
tution has  confirmed  the  wisdom  of  this  decision.  The  use  of  iron  gird- 
ers and  brick  arches  as  a  support  for  the  floors  was  consequently  deter- 
mined upon,  and  to  secure  additional  safety  all  connection  between  the 
wings  and  the  center  building  is  entirely  cut  off"  by  the  interposition  of 


325 


a  verandah  of  iron  and  glass,  with  communication  from  one  to  the  other 
only  through  fireproof  doors.  The  location  of  the  heating  apparatus 
and  the  kttchen,  in  detached  buildings,  renders  the  institution  quite 
exempt  from  danger  of  destruction  by  fire. 


CHAPEL. 

A  separate  building  immediately^  in  the  rear  of  the  centre  building, 
seventy  by  forty  feet  in  size,  contains  upon  its  first  floor  a  room  for 
chapel  purposes  capable  of  seating  three  hundred  and  eighty  persons. 
It  communicates  with  the  different  wards  by  means  of  covered  corridors, 
is  appropriately  fitted  up,  properly  warmed,  and  lighted  with  gas. 

KITCHEN. 

One  central  kitchen  is  intended  to  supply  the  whole  institution.  It  is 
placed  immediately  beneath  the  chapel  room,  with  storerooms  near  at 
hand,  and  communicates  with  the  dumbwaiters  of  the  difterent  dining- 
rooms  by  means  of  a  small  car  moving  upon  a  covered  railway.  The 
building  containing  the  chapel  room  and  kitchen  is  surmounted  by  a  bell 
and  clock  tower. 

WARMING   AND    VENTILATION. 

It  is  now  admitted,  as  a  principle,  that  the  warming  and  ventilation  of 
buildings  corresponding  in  size  and  purpose  with  institutions  for  the 
insane  should  be  efi'ected  by  one  and  the  same  process;  and  also  that 
means  should  be  adopted  for  expelling  the  foul  air  to  the  same  extent 
and  simultaneously  with  the  admission  of  fresh.  The  fact  is  also  estab- 
lished, and  in  many  asylums  has  been  confirmed  by  a  costly  experience, 
that  the  ordinary  system  of  making  the  ventilation  depend  upon  the 
spontaneous  action  of  warm-air  currents  failed  to  give  satisfactory 
results.  A  perfect  and  equable  distribution  of  fresh  air,  either  warm  or 
cold,  and  the  necessary  rapidity  in  the  discharge  of  foul  air,  under  all 
circumstances  and  in  all  seasons,  can  be  secured  only  by  a  system  of 
forced  ventilation.  This  is  found  to  be  most  eflSciently  and  economically 
effected  by  means  of  a  fan  driven  by  a  steam  engine — effectual,  because 
at  all  times  under  perfect  control;  and  economical,  because  the  warm 
air  is  more  thoroughly  and  rapidly  distributed.  The  primary  cost  is 
not  great;  it  is  not  liable  to  get  out  of  order,  and  the  motive  power  is 
that  required  for  other  purposes.  The  system  decided  upon  is  a  modifi- 
cation of  that  in  use  at  the  New  York  State  Lunatic  Asylum,  the  effi- 
ciency of  which  is  shown  by  the  fact  that  in  five  similar  institutions  in 
other  States  it  has  since  been  adopted  in  place  of  furnaces  and  other 
means  of  heating  and  ventilation  already  in  operation.  It  consists  of 
boilers,  an  engine,  a  fan,  heating  surface,  and  distributing  ducts,  and 
inlet  flues,  with  exit  flues,  foul  air  ducts,  and  ventilating  cupolas.  The 
boilers  are  four  in  number;  these,  with  the  engine  and  fan  (the  latter 
peculiar  from  the  circumstance  of  its  delivering  the  air  in  the  direction 
of  its  axis),  and  the  heating  surface,  consisting  of  a  series  oi:  wrought- 
iron  pipes,  are  all  in  a  separate  and  detached  building.  The  air,  after 
Its  delivery  from  the  fiin,  passes  directly  forward  beneath  the  chapel. 
The  main  duct  conveying  it  gives  oft"  a  small  branch  to  the  chapel,  and 
another  to  the  centre  building;  it  then  branches  toward  either  wing,  and  ' 
another  subdivision  is  made,  one  portion  x)assing  beneath  the  first  longi- 


326 

tudinal  wing,  and  the  other,  entering  the  proximal  end  of  the  second 
wing,  passes  on  to  the  end  of  the  extreme  wing.  The  air  passage 
beneath  the  building  occuj^ies  the  middle  portion  of  the  basement,  or 
rather  the  space  immediately  beneath  the  floors  of  the  corridors,  and 
the  distributing  flues  pass  up  in  the  walls  upon  either  side  of  them. 
Exit  flues  are  carried  up  in  the  same  walls,  taking  their  departure  from 
two  points,  one  near  the  ceiling,  and  the  other  near  the  floor  of  the 
rooms  on  either  side;  these  again  conjoin  in  the  attics  to  form  the  foul 
air  ducts  and  empty  out  into  the  open  air  through  the  ventilating  cupolas. 
Downward  currents  of  air,  for  the  ventilation  of  the  water  closets,  will 
be  secured  through  an  arrangement  of  pipes  terminating  in  the  fire 
boxes  of  the  boilers. 

LAUNDRY   AND   WORKSHOPS. 

The  right  wing  of  the  engine  and  boilerhouse  contains  the  washroom, 
drying  and  ironing  rooms;  and  a  similar  wing  upon  the  other  side  fur- 
nishes convenient  rooms  for  the  usual  workshops.  A  close  partition 
running  from  the  rear  of  the  chapel  to  the  engine  house,  with  a  covered 
j^assageway  on  either  side,  provides  ready  and  protected  access  to  the 
shops  and  ironing  rooms  from  the  various  wards  in  the  house,  and  at 
the  same  time  prevents  all  communication  between  the  sexes. 

WATER. 

Water  for  drinking  purposes  is  drawn  from  a  well,  while  that  for 
bathing  and  laundry  purposes  is  forced  up  from  a  stream  flowing  in  the 
valley,  immediately  in  the  rear  of  the  institution. 

DRAINAGE    AND    SEWERAGE. 

Cast  iron  pipes  will  be  used  for  connecting  drainage  in  the  rear  of  the 
wings,  and  will  pass  forward  beneath  the  building  at  a  single  point  only 
on  either  side.  The  drains  and  branch  sewers  will  unite  in  front,  and 
pour  into  the  common  sewer,  which  is  of  brick,  egg-shf,ped,  three  feet 
high,  and  two  feet  wide.  This  runs  down  the  ravine  in  front  of  the 
institution,  and  empties  into  a  depot  for  the  collection  of  solid  material. 

ILLUMINATION. 

It  is  now  universally  conceded  that  gas  is  the  only  proper  material  to 
be  used  in  lighting  asylums  for  the  insane.  To  obviate  the  only  objec- 
tion to  its  manufacture  upon  the  premises,  the  gashouse  will  be  placed 
just  below  the  depot  referred  to.  The  gas  main  will  be  carried  up  to 
the  institution  in  the  sewer,  attached  to  its  upper  arch. 

The  completeness  of  this  description  renders  any  further  analj^sis  of 
the  internal  arrangement  of  the  institution  quite  unnecessary.  To  those 
familiar  with  the  construction  of  asjdums  for  the  insane  a  reference  to 
the  engraving  and  lithograph  will  supply  any  omission  that  may  have 
occurred.  The  j^lans  of  the  building,  as  given  iu  the  preceding  sketch, 
have  been  submitted  to  and  received  the  unqualified  approval  of  many  of 
the  more  experienced  physicians  in  charge  of  similar  institutions;  and 
from  those  most  capable  of  judging,  the  Board  have  received  the  grati- 
fying assurance  that  their  efforts  to  combine  in  one  the  acknowledged 
excellences    of    several    recently    erected    establishments,    with    such 


327 

improvements  as  careful  study  and  experienced  assistance  suggested, 
have  not  been  unsuccessful. 

EXPLANATIONS     OF     THE    PLATE.     (App.    F.) 

In  the  accompanying  plate,  all  portions  of  the  institution  represented 
in  shaded  Imes  are  already  built,  with  the  exception  of  the  "  Infirmary 
for  Males  "and  the  chapel  and  kitchen.  The  portions  represented  in 
outline  constitute,  collectively,  the  north  wing. 

"Hall  No.  1"  constitutes  the  portion  known  as  the  first  longitudinal 
division.  Adjoining  it  at  the  left  is  the  first  transverse  division,  which 
is  connected  with  the  second  transverse  division  by  the  second  longi- 
tudinal, designated  as  "  Hall  No.  3."  "  Hall  No.  5 "  and  the  wards 
beyond  it  are  collectively  known  as  the  extreme  wing.  The  transverse 
divisions  are  three  and  all  other  portions  of  the  wing  two  stories  high. 
The  divisions  of  the  north  wing  are  the  same. 

Eeferences.— A,  Trustees'  room;  B,  general  ofiice;  C,  Matron's  room; 
D,  Steward's  office;  E,  E,  reception  rooms;  F,  dining  room;  G,  medical 
office;  H,  safe  on  the  left  and  water  closet  on  the  right;  K,  associated 
dormitories;  M,  recesses;  N,  day  rooms;  O,  ward  dining  rooms ;  U,  chapel 
and  kitchen;  1,  boiler  room;  2,  engine  room;  3,  laundry;  4,  drying  room; 
5  and  6,  ironing  and  distributing  rooms;  8,  fan  room. 


PENNSYLVANIA  HOSPITAL   FOR   THE  INSANE. 

The  Pennsylvania  Hospital  for  the  Insane,  as  now  constituted,  con- 
sists of  two  distinct  buildings,  each  complete  in  itself,  having  separate 
pleasure  grounds  and  inclosures,  both  situated,  however,  on  the  same 
tract  of  one  hundred  and  thirteen  acres  of  land  originally  purchased 
by  the  institution.  The  hospital  just  completed  is  styled  "the  Depart- 
ment for  Males,"  and  that  which  has  been  in  use  during  the  last  nine- 
teen years,  "  the  Department  for  Females."  Both  departments  remain 
as  heretofore  under  the  charge  of  a  Physician  in  Chief,  and  who  now 
has  as  associate  officers  one  or  more  assistant  physicians,  a  steward,  and 
a  Matron  in  each  building. 

This  new  hospital  faces  to  the  west,  and  consists  of  a  centre  building, 
with  wings  running  north  and  south,  making  a  front  of  five  hundred  and 
twelve  feet;  of  other  wings,  connected  with  each  of  those  just  referred  to, 
running  east  a  distance  of  one  hundred  and  sixty-seven  feet,  all  three 
stories  high,  and  these  last  having  at  their  extreme  ends  communications 
with  extensive  one-storied  buildings.  All  the  exterior  walls  are  of  stone, 
stuccoed,  and  the  interior  are  of  brick. 

This  arrangement  gives  provision  for  the  accommodation  of  sixteen 
distinct  classes  of  male  patients  in  the  new  building,  as  the  same  num- 
ber of  classes  of  females  are  now  provided  for  in  that  previously  in 
use.  Each  one  of  these  sixteen  wards  has  connected  with  it,  besides 
the  corridors  for  promenading  and  the  chambers  of  the  patients  and 
attendants,  a  parlor,  a  dining  room,  a  bath  room,  a  water  closet,  a 
urinal,  a  sink  room,  a  wash  room,  a  drying  closet,  a  storeroom  for 
brushes  and  buckets,  a  clothes  room,  a  dumb  waiter,  a  dust  flue,  and  a 
stairway  passing  out  of  doors,  if  desired,  without  communication  with. 


328 

the  other  wards;  and  every  room  iu  the  buikling,  almost  without  excep- 
tion, has  a  flue  communicating  with  the  fresh  air  duct  for  warm  or  cool 
air,  according  to  the  season  (and  hereafter  to  be  referred  to),  and  with 
the  main  ventilating  trunks  which  terminate  in  the  various  ventilators 
on  the  roof  of  the  building. 

The  centre  building  is  one  hundred  and  fifteen  by  seventy-three  feet. 
It  has  a  handsome  Doric  portico  of  granite  in  front,  and  is  surmounted 
by  a  dome  of  good  proportions,  in  which  are  placed  the  iron  tanks  from 
w4iich  the  whole  building  is  supplied  with  water.  The  lantern  on  the 
dome  is  one  hundred  and  nineteen  feet  from  the  pavement,  and  from  it  is 
a  beautiful  panoramic  view  of  the  fertile  and  highly  improved  surround- 
ing country,  the  Delaware  and  Schuylkill  Elvers,  and  the  City  of  Phila- 
delphia, with  its  many  pi;ominent  objects  of  interest.  In  the  basement 
or  first  story  of  the  centre  building 'is  the  main  kitchen,  forty-two  by 
twenty-four  feet,  in  which  are  improved  arrangements  for  cooking — a 
scullery,  twenty-four  hy  eleven;  two  storerooms,  each  about  twenty  by 
twenty-two  feet;  a  trunk  room,  twenty-four  by  twelve  feet;  a  general 
clothes  room,  a  bread  room,  a  dining  room  for  the  officers,  another  for 
the  domestics,  a  lodging  room  for  the  seamstress,  another  for  the  super- 
visor of  the  basement,  a  stairway  to  the  main  story,  and  a  dumb  waiter 
leading  from  the  kitchen  to  the  cellar,  and  another  to  the  upper  rooms 
of  the  centre  building.  The  cellars  under  the  centre  building,  besides 
containing  the  hot  air  chambers  for  that  division  of  the  house,  have 
three  distinct  rooms  for  storage,  which  are  ventilated  by  means  of  flues 
leading  out  through  the  roof  of  the  house.  In  front  of  the  basement 
and  under  the  steps  and  adjoining  roadway  are  the  vaults  for  coal  for 
the  kitchen  and  bake  room,  and  the  ice  house,  the  latter  being  ventilated 
as  mentioned  for  the  cellars;  and  carts  unload  into  both,  through  open- 
ings in  the  blue  stone  flagging,  which  forms  the  roadway  upon  the  arches 
below.  Adjoining  the  ice  house  is  a  small  apartment  with  stone  shelves, 
for  keeping  food  cool  in  Summer;  and  alongside  the  coal  vault  is  a  space 
for  the  oflal  from  the  kitchen.  There  is  also  a  small  kitchen  near  the 
scullery,  and  intended  for  the  Superintendent's  family,  whenever  it  is 
required  for  the  purpose.  In  one  of  the  storerooms  is  a  dark  apartment, 
and  in  another  the  tanks  tor  the  oxygen  and  hj^drogen  gases  used  in  the 
dissolving  apparatus. 

On  the  second  or  principal  story  is  the  lecture  room,  forty-two  by 
twenty-four  feet,  in  the  lecturer's  table  of  which,  water,  steam,  and  gas, 
for  experimental  purposes  have  been  introduced.  It  also  contains  com- 
modious cases  for  apparatus,  a  blackboard  running  on  a  track  behind 
the  cases,  and  a  smooth  surface  twenty -four  by  eighteen  feet,  at  its 
eastern  end,  on  w^hich  the  dissolving  views  are  shown.  On  the  opposite 
side  of  the  main  corridor  is  a  reception  room  for  visitors,  and  a  room  for 
visits  to  patients  b}'  their  friends,  each  being  twenty-four  by  twenty- 
three  feet.  There  are  also  on  this  floor  two  small  rooms  for  more  pri- 
vate visits,  the  medical  office  and  library,  which  is  also  the  Assistant 
Physician's  oflice,  twenty-four  by  fourteen  feet,  with  a  small  storeroom, 
containing  a  sink,  etc.,  adjoining;  the  lodging  room  for  the  Assistant 
Physician  having  charge  of  the  medical  office,  with  which  it  communi- 
cates; a  general  business  office,  which  is  also  that  of  the  steward,  twenty- 
four  by  twenty  feet;  a  numager's  room,  twenty-four  by  nineteen  feet, 
which  is  also  the  Principal  Physician's  private  office;  a  parlor  twenty- 
four  by  nineteen  feet,  for  the  use  of  the  officers  of  the  house,  and  a  fire- 
proof, eleven  by  nine  feet,  in  connection  with  the  general  business  office. 
In  the  third  story  front  are  four  fine  rooms,  each  twenty-four  by  twenty- 


one  feet;  a  corridor,  forty -two  by  sixteen  feet,  shut  off  from  the  adjoin- 
ing portion  by  a  ground  glass  partition;  a  batliing  room,  water  closet, 
and  clothes  closets,  intended  at  some  future  day  for  the  use  of  the 
family  of  the  superintending  physician,  whenever  such  an  officer  may 
be  specially  connected  with  tluit  department.  There  are  also  on  this 
floor,  chambers  for  the  Steward  and  Matron,  for  the  Senior  Assistant 
Physician,  three  others  that  may  be  used  as  deemed  expedient,  and  a 
room  twenty-four  by  eleven  feet,  lighted  from  the  roof,  and  intended  for 
a  general  storeroom  for  the  bedding  and  other  dry  goods  not  actually  in 
use.  The  corridors  of  the  centre  building,  running  east  and  west,  are 
sixteen  feet  wide;  those  running  north  and  south,  in  which  are  the 
stairways,  lighted  from  the  roof,  are  twelve  feet  wide.  The  height  of 
the  ceiling  of  the  basement  in  the  centre  building,  and  of  all  parts  of 
the  wings',  which  is  one  foot  more,  is  twelve  feet.  The  ceilings  in  the 
second  or  principal  and  in  the  third  story  of  the  centre,  are  eighteen 
feet  high. 

TheVings  on  each  side  of  the  centre  building  are  almost  exactly 
alike,  except  that  on  the  south  side  in  front,  in  the  basement  immediately 
adjoining  the  centre,  is  the  ironing  room,  twenty-eight  by  eleven  feet, 
with  a  drying  closet,  eleven  by  eleven  feet,  attached,  and  in  the  rear  the 
small  kitchen  already  referred  to,  and  the  lodging  rooms  of  the  female 
domestics;  while  on  the  north  side  in  corresponding  positions,  are  the 
bake  room,  the  baker's  store  and  lodging  rooms,  and  the  lodging  room 
of  the  hired  men  not  employed  in  the  wards.  On  this  floor  on  each  side 
of  the  centre  is  also  a  museum  and  reading  room,  forty-two  by  fourteen 
feet,  and  accessible  either  from  the  grounds  or  from  the  inside  of  the 
building;  two  work  rooms  for  the  patients;  two  lodging  rooms  for  per- 
sons employed  in  the  Avork  rooms;  a  bath  room  for  the  officers,  and 
another  for  the  domestics;  two  water  closets,  etc.  The  portion  of  the 
wing  just  described  is  shut  off  from  the  adjoining  part  (which  constitutes 
the  fifth  ward)  by  a  thick  ground  glass  partition;  this  ward  having  in 
it  a  large  room,  twenty-nine  by  twenty-four  feet,  with  a  bath  tub  and 
water  closets  in  a  recess;  another  twenty-four  by  fourteen  feet;  a  third 
twenty-three  by  eleven  feet,  and  five  rooms  eleven  by  nine  feet,  a  bath 
room,  drjdng  closet,  and  all  the  other  conveniences  already  mentioned  as 
forming  a  part  of  each  ward.  These  apartments  and  arrangements  are 
all  intended  for  patients  who  are  particularly  ill,  and  who  require  special 
quiet  and  seclusion,  where  they  may  be  visited,  if  deemed  expedient,  by 
their  friends  without  annoyance  to  others,  or  interfering  with  the  dis- 
cipline of  the  house. 

Besides  the  fifth  ward,  just  described,  and  which  is  on  the  first  floor, 
there  are,  on  each  side  of  the  centre,  two  other  stories,  each  of  which 
constitutes  a  ward,  and  with  all  the  conveniences  already  referred  to. 
The  rooms  are  arranged  on  both  sides  of  the  corridors,  which  are  twelve 
feet -wide,  and  have  their  extreme  ends  mostly  filled  with  glass;  while, 
wherever  one  wing  joins  another,  there  is  entirely  across  it  an  open 
space  for  light  and  air  eight  feet  wide,  glazed  with  small  sash  from  near 
the  floor  to  the  ceiling;  and  in  the  middle  of  each  ward,  on  one  side,  is  a 
similar  open  space,  all  of  which  may  be  used  for  keeping  flo\yering 
plants,  birds,  etc.,  for  having  small  jets  of  water,  or  any  other  object  of 
interest,  and  which,  in  excited  wards,  may  be  guarded  by  ornamental 
wire  work.  Each  story  of  the  return  wing  makes  a  ward  similar  to 
those  just  described.     Passing  from  the  return  Avings  into  the  Super- 

42 


330 

visor's  office,  the  one-storied  buildings  are  reached.  Each  of  these  has 
provision  for  twentv-six  patients  and  six  attendants,  and  every  arrange- 
ment for  their  comfort.  The  rooms  are  here  on  one  side  of  a  corridor 
ten  feet  wide,  and  at  the  end  of  each  of  those  running  towards  the  east 
is  a  cross  hall,  in  which  are  three  roonis  intended  particularly  for  pa- 
tients who  from  any  cause  ma}^  require  special  seclusion.  One  of  the 
main  halls  is  used  for  dining,  and  the  other  as  a  sitting  room.  Between 
the  dining  halls  of  these  two  wards  (the  seventh  and  eighth),  and  made 
private  by  sliding  doors,  are  four  rooms  intended  for  excited  patients 
who  have  special  attendants.  Opposite  these  last  is  a  room  one  hun- 
dred and  ten  by  fourteen  feet,  with  an  arched  ceiling  fifteen  feet  high, 
with  skylights  and  windows  out  of  reach,  intended  to  be  used  as  a  kind 
of  gymnasium,  and  accessible  either  from  the  adjacent  garden  and  j^ards, 
or  directly  from  the  wards;  and  in  the  story  below  this  is  a  room  of  the 
same  size,  in  which  are  two  fine  bowling  alleys,  with  reading  tables,  etc. 
Both  these  rooms  may  be  well  lighted  with  gas,  and  warmed  by  steam 
pipe,  so  that  they  can  be  comfortably  used  in  the  evening  as  well  as  by 
day,  and  in  all  kinds  of  weather. 

The  arrangement  of  these  one-storied  buildings  makes  for  each  two 
very  pleasant  yards,  in  size  one  hundred  and  ten  by  fifty-four  feet,  sur- 
rounded by  broad  brick  pavements,  and  having  grass  in  the  centre,  with 
an  open  iron  palisade  in  front,  giving  a  distinct  though  sufficiently  dis- 
tant view  of  two  of  the  most  traveled  roads  in  the  vicinity.  There  is 
also  a  yard,  three  hundred  and  forty -three  by  seventy-two  feet,  adjoin- 
ing each  sixth  ward,  fitted  up  as  the  others,  and  planted  with  shade 
trees.  Brick  pavements  also  surround  the  entire  building,  making,  with 
those  just  referred  to  and  those  in  front,  a  continuous  walk  of  six  thou- 
sand one  hundred  and  fifty-two  feet. 

ENTRANCE. 

The  entrance  to  the  department  for  males,  as  before  mentioned,  is 
from  Forty -ninth  street,  between  Market  and  Haverford  streets.  The 
gatekeeper's  lodge  has  two  comfortable  rooms  on  the  north,  while  on 
the  opposite  side  of  the  gateway  is  a  dead  room  and  another  for  tools 
used  about  the  grounds.  Brick  paths  on  either  side  of  the  main  road- 
way lead  'to  the  centre  building,  and  the  space  in  front,  planted  with 
evergreen  and  ornamental  trees,  and  having  a  fountain  in  the  central 
grassplat,  is  three  hundred  and  twenty -five  by  one  hundred  and  seventy- 
five  feet.  From  the  front  platform,  eight  steps  lead  uj)  to  the  vestibule 
and  seven  steps  inside  of  the  building  to  the  level  of  the  principal  floor. 
Visitors  passing  into  the  centre  building  may  go  out  upon  a  pleasant 
balcony*  on  its  eastern  side  and  overlook  the  improvements  in  that 
direction,  but  they  cannot  pass  through  the  grounds. 

Ten  steps  descend  from  the  roadway  to  the  pavement  around,  the 
basement,  which,  except  immediatel}^  at  the  front  of  the  centre,  where 
it  is  surrounded  by  a  wide  area  with  sodded  banks,  is  everywhere  above 
ground. 

There  is  also  a  gate  on  Market  street,  near  the  engine  house,  used  for 
bringing  in  coal  or  other  heavy  articles,  and  another  on  the  eastern  side 
of  the  grounds,  for  the  use  of  the  officers  of  the  hospital  only. 

ENGINE  HOUSE  AND  LAUNDRY. 

The  engine  house,  seventy-one  feet  from  the  nearest  jDoint  of  the  hos- 


331 

pital  building,  is  a  substantial  stone  structure,  seventy  by  sixty-four 
feet,  and  two  stories  in  heigdit.  The  character  of  the  ground  is  such  that 
carts  drive  into  the  second  story  to  discharge  the  coal  directly  into  the 
vaults  below,  and  the  level  of  the  railroad  in  the  cellar  of  the  hospital 
brings  it  upon  the  second  floor  of  the  engine  house. 

The  first  story,  on  the  level  of  the  ground  on  its  southern  and  eastern 
side,  contains  vaults  capable  of  containing  near  five  hundred  tons  of 
coal.  Adjoining  these  vaults  is  the  boiler  room,  thirty  by  seventeen 
feet,  and  opening  into  the  engineer's  work  room,  in  which  will  be  placed 
lathes,  grindstones,  pipe  cutting  machines,  etc.,  driven  by  the  engines 
which  are  in  the  engine  room,  twenty  three  by  nineteen  feet  in  size,  and 
separated  from  the  last  by  a  glass  partition ;  while  further  west,  also 
separated  by  glazed  windows  and  doors,  is  the  fan  room,  and  the  tower 
for  supplying  fresh  air  to  the  main  duct,  which  leads  from  it  through 
the  entire  building.  The  height  of  ceiling  in  this  story  is  seventeen 
feet,  and  it  is  arched  over  the  engine  room  and  the  engineer's  work 
room,  so  as  to  give  a  proper  support  to  the  stone  floor  of  the  room  above. 
In  the  second  story  of  this  building,  into  which  the  railroad  passes,  is 
the  wash  room,  twenty-seven  by  twenty-four  feet;  the  room  for  assort- 
ing and  folding  clothes,  twenty-four  by  fourteen  feet;  the  mangle  room, 
forty-three  by  eight  and  a  half  feet;  the  drying  closet,  occupying  a  space 
twenty-six  by  thirteen  feet;  a  water  closet,  and  a  large  room  over  the 
coal  vaults  and  boilers,  surrounded  by  movable  blinds,  and  intended  for 
drying  clothes  without  the  use  of  artificial  heat,  for  making  soap,  etc. 

The  carpenter  shop,  thirty-six  by  fifty  feet,  is  of  frame,  two  stories 
high,  and  forty -five  feet  from  the  engine  house,  from  which  steam 
may  be  taken  for  warming  it  in  the  winter.  It  has  two  rooms  below, 
and  a  single  large  one  above. 

The  carriage  house  and  stables  make  a  neat  stone  structure,  fifty  seven 
by  thirty-six  feet,  and  two  stories  high.  It  has  accommodations  for  six 
horses  and  as  many  cows,  and  the  carriages  required  for  the  difierent 
purposes  of  the  institution.  The  lower  floor  is  of  «ement,  brick,  or  blue 
stone.  The  j^iggery  is  in  the  yard  in  the  rear  of  the  stables,  and  there 
is  a  carriage  yard  in  front,  both  being  surrounded  by  a  stone  wall. 

SIZE     OP    ROOMS. 

The  height  of  the  ceilings  throughout  the  building,  and  the  size  of  the 
parlors,  and  of  all  the  rooms  in  the  centre  of  the  building,  have  been 
already  given.  The  ordinary  size.of  the  patients'  lodging  rooms  is  nine 
by  eleven  feet,  while  there  are  some  in  each  ward  of  a  much  larger  size, 
many  of  which  have  communicating  doors  and  are  intended  for  patients 
who  desire  a  parlor  as  w^ell  as  a  chamber,  or  for  those  having  special 
attendants.  The  parlors  in  the  first  and  third  wards  are  thirty-three  by 
twenty-four  feet,  and  in  the  second,  fourth,  and  sixth,  they  are  twenty- 
three  by  thirty  feet.  The  dining  rooms  are  generally  twenty-three  by 
seventeen  feet.  The  bath  rooms  are  mostly  nine  by  eleven  feet.  Six- 
teen rooms  in  each  one-storied  building  have  water  closets  in  them, 
firmly  secured,  and  with  a  strong  downward  draught.  The  sides  of 
doors  and  windows  in  patients'  rooms  are  generallj-  rounded,  by  being 
built  of  brick  made  expressly  for  the  purpose,  and  smoothly  plastered. 

WINDOWS  AND  WINDOW  GUARDS. 

The  windows  in  patients'  rooms  are  almost  universally  six  feet  by 


332 

two  feet  Dine  inches,  having  twenty  lights  of  glass,  six  by  seventeen 
inches  in  each.  In  the  front  wings  adjoining  the  centre,  and  in  the 
third  story  of  the  return  wings,  both  sashes  are  of  cast  iron,  secured  in 
wooden  frames,  so  arranged  as  to  balance  each  other,  rising  and  falling 
only  to  the  extent  of  five  and  a  half  inches,  and  doing  away  with  the 
necessity  for  guards.  In  the  other  parts  of  the  return  wings,  and  in  the 
one-storied  buildings,  the  windows  are  of  the  same  size,  having  the 
upper  sash  of  cast  iron  and  immovable,  the  lower  being  of  wood,  rising 
to  its  full  extent  and  protected  by  an  ornamental  wrought  iron  guard, 
securely  fastened  on  the  outside.  A  few  rooms  in  each  one  story  build- 
ing have  small  windows  out  of  reach  of  their  occupants,  and  intended 
for  the  temporary  seclusion  of  very  violent  or  mischievous  patients.  In 
other  parts,  as  well  as  in  this,  wire  screens  inside  of  the  rooms  are  occa- 
sionally used  to  protect  glass,  and  ornamental  wire  work  is  adopted  in 
some  of  the  parlors,  at  the  ends  of  corridors  and  in  other  similar  posi- 
tions, as  a  guard  outside  of  the  windows. 

DOORS. 

The  doors  throughout  are  made  of  the  best  white  pine  lumber.  In 
the  wards  the}^  are  one  and  three  fourth  inches  thick,  six  feet  eight 
inches  high  by  two  feet  seven  inches  wide.  Each  door  has  eight  panels 
in  it,  one  of  which  makes  a  hinged  wicket,  and  what  is  commonly 
known  as  bead  and  butt,  very  substantially  put  together,  and  wherever 
special  strength  is  required  it  is  obtained  by  transverse  pieces  of  iron 
let  into  the  wood,  or  by  plates  of  boiler  iron  screwed  on  and  painted  so 
as  to  resemble  an  ordinary  door.  Each  door  has  a  good  dead  lock  to  it, 
and  occasionally  a  mortise  bolt  is  added.  Over  each  door  is  an  unglazed 
sash,  thirty-one  by  seventeen  inches,  covered  with  fine  wire  on  the 
inside,  or  a  space  thirty-one  by  five  inches,  which  can  be  filled  up  at 
pleasure  by  a  tight  board  or  by  wire.  Lift  hinges  have  been  used  for 
all  these  doors,  whidi  for  patients'  lodging  rooms  always  open  into  the 
corridors. 

FLOORS. 

The  floors  throughout  are  of  the  best  yellow  pine,  cut  to  order  in 
Florida  and  piled  up  on  the  grounds  two  years  before  it  was  used.  The 
boards  are  one  inch  and  a  quarter  thick,  varying  in  width  from  two  and 
a  quarter  to  four  inches,  and  put  down  with  secret  nailing.  Counter 
ceiling  is  everywhere  used.  The  onlj^  exception  to  this  kind  of  flooring 
is  in  the  two  kitchens,  the  scullery,  a  sj^ace  in  the  basement  hall  in 
front,  the  bake  room,  all  the  sink,  water  closet,  and  wash  rooms,  the 
line  between  different  wards,  the  entrance  to  the  stairways,  and  the 
main  wash  room  in  the  engine  house,  which  are  of  brown  German  flag- 
stones laid  on  brick  arches;  the  engineer's  work  room,  which  is  paved 
with  brick;  the  front  of  the  boiler  room,  which  is  of  iron  and  blue  stone 
flagging;  and  the  engine  room,  one  sink  room,  and  all  the  ward  stair- 
ways, which  are  of  slate,  admirably  adapted  to  such  a  j^urpose,  and. 
which  has  also  been  used  extensively  for  window  sills,  stairways,  and 
other  purposes. 

STAIRWAYS. 

All  the  stairways  in  those  parts  of  the  building  occuj^ied  by  patients 
are  fire  proof.  The  framework  i§,  of  cast  iron,  built  into  the  brick  work 
on  each  side  and  covered  with  slate,  which  has  many  advantages.     The 


333 

rise  of  these  steps  is  only  seven  inches,  and  there  are  pLatforms  every 
five  or  six  steps,  with  convenient  handrails  on  botli  sides  from  top  to 
bottom.  They  are  all  well  lighted  by  windows  by  day  and  by  gas  at 
night.  The  well  around  which  the  stairs  wind  is  used  for  hat  or  coat 
rooms  for  the  different  stories. 

PLASTERING. 

The  inside  plastering  is  what  is  called  hard  finish,  composed  of  lime 
and  sand,  without  plaster  of  Paris,  except  for  ceilings,  and  well  trowelled. 
This  fihish  admits  of  being  scrubbed  for  years  without  injury,  and  is  at 
all  times  ready  for  painting.  The  outside  of  the  building  is  rough  cast, 
the  material  used  being  the  pulverized  stone  of  which  the  house  is  built 
and  lime,  to  which  an  agreable  shade  of  color  is  given  by  sand.  Hy- 
draulic cement  is  used  near  the  ground  in  certain  j^ositions,  in  many  of 
the  sink  and  wash  rooms,  in  the  kitchen  and  scullery,  in  the  main  wash 
room,  and  as  a  substitute  for  the  ordinary  wash  boards  in  many  of  the 
ward  corridors  and  patients'  chambers. 

ROOFING. 

The  roof  is  of  Pennsylvania  slate,  fastened  on  lath,  and  plastered  with 
hair  mortar  on  the  under  and  upper  edges,  and  on  the  joints  of  the 
slate.  The  pitch  is  one  fourth  of  the  span.  The  water  from  the  roof  is 
carried  off  through  four  inch  cast  iron  pipes,  inside  of  the  building,  and 
easily  accessible,  into  large  drains  leading  into  the  main  culvert. 

SEWERAGE. 

The  main  culvert  is  two  thousand  and  thirty-two  feet  in  length.  It  is 
thirty-five  inches  from  top  to  bottom  in  the  clear,  built  of  brick  laid  in 
hydraulic  cement,  egg-shaped,  the  smaller  part  being  at  the  bottom. 
Beginning  near  the  intersection  of  the  north  return  wing  and  one-storied 
buildings,  at  which  point  it  receives  various  pipes  from  the  adjacent 
wards,  it  passes  under  the  main  chimney,  by  the  engine  house  and  barn, 
and  extends  to  Mill  Creek,  into  which  it  discharges  just  before  it  reaches 
Market  street.  Through  this  culvert  all  the  drainage  from  the  building 
and  much  of  the  grounds  is  carried  off,  being  intersected  by  branch 
culverts  at  various  points  in  its  course. 

BATH    ROOMS,    WATER    CLOSETS,    ETC. 

There  are  twenty-one  bath  rooms  and  as  many  water  closets  in  the 
building,  in  addition  to  those  in  the  patients'  rooms.  Sixteen  are  in  the 
wards.  Each  bath  room  has  in  it  a  cast  iron  bath  tub,  covered  with 
zinc  paint,  and  with  improved  arrangements  for  the  admission  and  dis- 
charge of  water  through  the  bottom.  In  addition  to  the  ordinary  hot 
air  flue,  there  is  a  coil  of  steam  pipe  for  direct  radiation  in  each,  so  that 
when  hot  baths  are  used  the  temperature  of  the  room  may  be  made  so 
high  as  to  prevent  the  sensation  of  chilliness  when  coming  froni  the 
water.  The  water  pipes  in  these  rooms  arc  generally  of  galvanized  iron, 
left  exposed,  so  as  to  be  readily  accessible,  and  passing  from  story  to 
story  through  castings  made  for  the  purpose,  so  that  in  case  of  leakage 
the  ceilings  may  not  be  injured. 

The  water  closets  are  of  cast  iron,  enameled,  have  no  traps,  but  are 


334 

open,  so  as  to  have  a  constant  downward  draught  of  air  tlirongli  them 
into  the  main  chimney,  as  have  all  the  sinks,  bath  tubs,  etc.,  in  the  whole 
establishment.     The  water  is  let  on  by  the  opening  of  the  door. 

The  wash  basins  in  the  wash  rooms  are  of  marble,  with  strong  swing 
cocks.  The  sinks  are  of  cast  iron,  and  have  hot  and  cold  water  at  each. 
There  is  also  an  iron  hopper  to  each,  and  into  which  the  slops,  etc.,  are 
emptied.  There  are  permanent  fixtures  for  securing  the  towels  m  each 
wash  room.  The  di'ying  closets  are  sufficiently  large  to  contain  a  bed, 
and  like  the  closets  for  buckets,  etc.,  have  fines  leading  into  and  from 
them,  and  thus  secure  a  direct  communication  with  the  fan  belo.w  and 
the  ventilating  ducts  above.  All  these  arrangements  in  each  ward  are 
clustered  together,  and  have  scarcely  any  wood  in  any  part  to  absorb 
moisture  or  retain  unpleasant  odors. 

SUPPLY    OF   WATER. 

The  new  hospital  is  suplied  with  water  from  a  well  twenty-five  feet 
in  diameter,  containiDg  fifty  thousand  gallons,  and  into  which,  as  meas- 
ured at  the  dryest  period  of  the  last  year,  is  a  daily  flow  of  thirty  thou- 
sand gallons  of  excellent  water.  There  is  also  a  constant  stream  of 
spring  water  passing  near  the  well,  which  can  at  any  time  be  turned 
into  it.  By  means  of  one  of  Worthington's  combined  direct  acting 
steam  pumj^s,  capable  of  raising  ten  thousand  gallons  per  hour,  this 
water  is  forced  through  seven  hundred  and  eight  feet  of  six  inch  cast 
iron  pipe  into  the  four  boiler  iron  tanks  in  the  dome,  and  from  which  it  is 
distributed  through  the  entire  building.  These  tanks  are  one  hundred 
and  three  feet  above  the  well,  and  contain  twenty-one  thousand  gallons. 
The}'  are  so  arranged  that  one  or  all  may  be  used  at  pleasure;  have 
overflows  and  pipes  through  which  they  may  have  the  sediment  washed 
out  whenever  deemed  desirable.  The  elevation  of  these  tanks  is  suffi- 
cient to  secure  the  feeding  of  the  steam  boilers  when  carrying  a  pressure 
of  forty  pounds  to  the  inch.  These  tanks  were  made  at  the  works  and 
put  in  place  before  the  roof  was  on  the  building.  It  is  intended  that 
they  shall  always  be  about  full  of  water,  and  a  small  pipe  leading  from 
them  to  the  engine  house  tells  the  engineer  on  duty  when  that  is  the  case. 
There  is  also  in  the  engine  room  a  single  ^Yorthington  steam  pumj:*,  capa- 
ble of  raising  five  thousand  gallons  per  hour,  and  intended  to  prevent 
any  possible  deficiency  of  water  should  an  accident  happen  to  the  larger 
engine.  The  rule  is  that  both  should  be  used  some  part  of  every  day, 
so  that  in  case  of  emergency  there  may  never  be  a  doubt  of  their  being 
in  working  order. 

The  tank  for  su2:)pl3ing  the  centre  building  with  hot  water  is  twelve 
feet  in  length  and  twenty-three  inches  in  diameter,  and  is  i^laced  above 
the  cooking  range,  the  heat  being  supplied  through  circulating  pipe  from  a 
waterback  behind  one  of  the  range  tires,  and  is  abundant  for  all  purposes. 
The  supply  of  hot  water  for  the  wards  is  derived  from  six  iron  tanks 
placed  in  the  most  convenient  points  in  the  cellar,  in  which  situations 
they  are  easily  accessible,  and  leakages  can  do  little  injury  to  the  build- 
ing. The  heat  is  derived  from  steam  coils  coming  from  the  summer 
pipe  (as  it  is  called)  used  for  cooking  and  all  other  purposes  except 
warming  the  building.  The  large  steam  boilers  at  the  engine  house  are 
supplied  with  hot  water  by  the  condensed  steam  used  in  heating,  which 
ordinarily  returns  to  them  by  gravity,  but  when  it  does  not  is  received 
into  an  iron  tank  and  forced  into  them  by  a  small  steam  pump.  The 
laundry  has  hot  water  from  a  large  tank  placed  in  the  oven^  which 


335 


covers  the  boilers,  and  tlirongh  which  the  exhaust  steam  from  the 
engines  and  pumps  can  be  made  to  pass  whenever  desired,  and  which 
nnty  be  also  used  for  feeding  the  large  boilers.  There  are  three  wells  of 
excellent  water  besides,  at  convenient  points  near  the  building,  and 
which  supplied  all  the  water  required  in  its  erection.  A  fourth  is  now 
beini»-  sunk  near  the  stable. 


-'to 

LIGHTING. 


The  hospital  is  lighted  by  gas  from  the  city  works.  The  fine  meter 
is  placed  in  the  engint  room,  and  a  record  is  made  every  morning  of  the 
consumption  during  the  preceding  night.  Stopcocks  are  placed  at  con- 
venient points  for  checking  the  flow  of  gas  through  the  main  pipes,  and 
the  ordinary  kinds  of  fixtures  have  been  adopted  throughout  the  build- 
ing. The  gas  is  also  used  for  experimental  purposes  in  the  lecture 
room,  and  for  boiling  water,  etc.,  in  the  medical  office. 

FURNITURE. 

The  furniture  is  intended  to  be  neat  and  plain,  but  of  a  comfortable 
and  substantial  character;  the  amount  in  the  various  apartments  being 
in  a  great  measure  dependent  on  the  character  of  the  patients  occupying 
them.  Carpets  of  some  kind  generally  cover  the  parlors,  and  some  por- 
tions of  the  corridors  and  chambers.  Wardrobes,  tables,  mirrors,  and 
other  conveniences  are  frequently  added  to  the  bedsteads,  which  are  of 
various  kinds,  mostly  of  wood,  but  many  are  of  wrought  or  cast  iron, 
painted  of  a  light  color,  a  few  of  which  last  are  secured  to  the  floor. 

HEATING    AND   VENTILATION. 

There  is  no  fire  used  in  any  part  of  the  hospital  for  heating,  although 
provision  for  open  fires  has  been  made  in  all  the  parlors  and  in  many  of 
the  other  large  rooms,  should  such  an  arrangement  ever  be  deemed 
desirable.  The  only  fires  kept  up  in  the  building  are  those  in  the 
kitchens,  bake  and  ironing  rooms. 

In  the  boiler  room  at  the  engine  house  there  are  three  large  tubular 
boilers.  Each  of  these  has  a  furnace  five  feet  three  inches  wide  by  five 
feet  three  inches  long  and  seven  feet  four  inches  high.  The  shell  is 
seventeen  feet  eight  inches  long  by  four  feet  six  inches  in  diameter. 
Combustion  chanlber  four  feet  long,  and  ninety-eight  tubes  two  and 
a  half  inches  in  diameter  and  eleven  feet  long.  The  total  heating  sur- 
face for  each  is  seven  hundred  and  forty-four  square  feet.  The  grate 
surface  is  twenty  and  a  quarter  square  feet.  The  escaping  gases  enter 
a  common  flue,  and  the  draft  can  be  regulated  by  a  damper  at  the  back 
end  of  each  boiler,  or  the  supply  of  air  graduated  by  a  register  in  the 
ashpit  door. 

These  boilers  furnish  steam  for  warming  the  entire  hospital,  and  for 
driving  all  the  machinery,  pumping  water,  for  ventilation,  washing, 
cooking,  etc.  They  are  so  arranged  that  one  or  all  may  be  used  at 
pleasure,  either  for  heating  or  driving  the  machinery.  The  steam  is 
carried  from  them  in  a  five-inch  welded  iron  pipe,  and  after  reaching 
the  hospital  building,  it  is  distributed  in  eighty-three  air  chambers, 
placed  in  its  cellar,  with  direct  flues  leading  from  them  to  the  apartments 
above.  The  gases  from  the  boiler  fires  pass  through  an  underground 
flue,  four  feet  wide  and  six  feet  high,  a  distance  of  five  hundred  and 


fifty-seven  feet,  rising  thirty-one  feet  in  its  course,  till  it  comes  to  the 
foot  of  the  main  chimney,  which  is  seventj-eight  feet  above  the  surface 
of  the  ground.  The  chimney  is  built  double,  the  interior  being  round, 
formed  of  hard  brick,  without  pargeting,  six  feet  in  diameter  in  the  clear 
from  bottom  to  top,  the  latter  being  formed  of  cast  iron,  while  the  foun- 
dation is  of  pointed  stone  work  to  a  height  of  eleven  feet,  and  the  re- 
mainder of  pressed  brick.  The  underground  flue  alluded  to  contains 
the  main  steampipe  until  it  reaches  the  nearest  point  of  the  building, 
and  also  that  portion  of  it  which  is  carried  to  the  north  section  of  the 
hospital,  and  is  immediately  over  the  main  culvert.  This  chimney  is 
made  the  ventilating  power  for  securing  a  strong  Jownward  draft  of  air 
through  all  the  water  closets,  urinals,  sinks,  and  bath  tubs  in  the  entire 
establishment,  and  for  this  reason  is  placed  in  a  central  position  on  the 
eastern  side  of  the  building.  The  coils  for  heating  are  composed  of 
welded  iron  pipes,  three  quarters  or  one  inch  in  diameter,  and  are  in 
two  sections  m  all  the  air  chambers,  so  that  one  or  both  may  be  used, 
according  to  the  severity  of  the  weather. 

In  the  engine  room  are  two  horizontal  high  pressure  steam  engines 
of  fine  finish.  They  are  exactly  alike,  each  having  a  cylinder  ten  inches 
in  diameter  and  a  stroke  of  twenty-lour  inches.  The}^  are  so  arranged 
that  either  may  be  substituted  for  the  other,  and  one  may  be  made  to  do 
the  work  of  both  in  case  of  emergency.  Ordinarily,  one  drives  the  fan, 
and  is  therefore  a  part  of  the  ventilating  apparatus,  while  the  second 
drives  all  the  other  machinery.  The  fan  is  of  cast  iron,  its  extreme 
diameter  being  sixteen  feet  and  its  greatest  width  four  feet.  It  is  driven 
directly  from  the  shaft  of  the  engine,  and  its  revolutions  vary  from 
thirty  to  sixty  per  minute,  according  to  the  requirements  of  the  house. 
The  fresh  air  is  received  from  a  tower  forty  feet  high,  so  that  all  surface 
exhalations  are  avoided,  and  is  then  driven  through  a  duct,  which  at  its 
commencement  is  eight  and  one  half  by  ten  and  one  half  feet,  into  the 
extreme  parts  of  the  building.  From  "the  cold  air  duct  openings  lead 
into  the  difterent  warm  air  chambers,  which  in  the  one  stoned  buildings 
are  covered  with  slate;  but  in  all  other  parts  of  the  hospital  these 
chambers  and  air  ducts  are  arched  with  brick  laid  with  smooth  joints. 
The  warm,  air  in  nearly  all  cases  is  admitted  near  the  floor  and  the  ven- 
tilators open  near  the  ceiling  always  in  the  interior  walls.  The  only 
exception  to  this  arrangement  is  in  the  one  storied  buildings,  in  which, 
in  the  patients'  rooms,  the  warm  air  is  admitted  above  and  the  venti- 
lators are  taken  off  near  the  floor.  All  the  ventilating  flues  terminate 
in  the  attic  in  close  ducts,  either  of  brick  or  wood,  smoothly  plastered, 
increasing  in  size  about  thirty  per  cent  more  rapidly  than  the  capacity 
of  the  flues  entering  them,  and  by  which,  through  the  different  belvi- 
deres  on  the  roof,  they  communicate  with  the  external  atmosphere.  In 
the  centre  building  the  ventilation  is  through  the  main  dome.  There  is 
no  leaden  pipe  used  in  the  building. 

COOKING   AND   DISTRIBUTION    OF    FOOD. 

All  the  cooking  is  done  in  the  central  kitchen,  which  has  in  it  a  large 
range  with  two  fires  and  three  ovens,  a  rotary  roaster,  a  double  iron 
steamer  containing  ninety  gallons,  a  smaller  one — iron  outside  and  cop- 
per tinned  on  the  inside — containing  forty-five  gallons,  and  six  of  tin  for 
vegetables,  besides  the  vessels  for  tea  and  coffee.  The  food  prepared  in 
this  room  is  put  into  closed  tin  boxes,  which  are  lowered  by  a  dumb 
waiter  to  the  car  standing  on  the  track  of  the  railroad,  where  it  passes 


337 

under  the  kitchen,  and  is  thus  conveyed  to  the  bottom  of  the  various 
dumb  waiters  which  lead  directly  to  the  different  dining  rooms  above,  of 
which,  as  before  remarked,  there  is  one  for  each  ward.  Each  dining 
room  has  a  steam  table  with  carving  dishes  on  it,  and  abundant  provis- 
ion for  keeping  meats  and  vegetables  warm  as  long  as  may  be  desired. 
The  dumb  waiters  are  all  controlled  by  the  person  having  charge  of  the 
railroad;  they  are  moved  by  a  crank  and  wheel,  and  wire  rope  is  substi- 
tuted for  that  commonly  adopted.  The  railroad  is  an  indispensable  part 
of  the  arrangements  for  distributing  food.  By  its  use  a  meal  may  be 
delivered  in  all  the  ward  dining  rooms  (eight  in  number)  on  one  side — 
the  extreme  ones  being  five  hundred  and  eighty  feet  distant — in  ten 
minutes  after  leaving  the  kitchen,  or  for  the  whole  sixteen  in  twenty 
minutes.  It  also  forms  a  very  convenient  mode  of  transporting  articles 
from  one  section  of  the  building  to  another,  carrying  clothing  to  and 
from  the  laundry,  and  gives  a  protected  passageway  in  going  from  the 
centre  building  to  the  engine  house,  barn,  and  workshoj),  and  for  persons 
visiting  their  friends  in  the  room  set  apart  for  the  purpose  between  the 
sixth  and  seventh  wards. 

PROVISION   AGAINST   FIRE. 

As  already  mentioned,  no  fires  are  required  in  the  building  for  warm- 
ing it,  and  gas  is  used  for  lighting.  Wherever  one  wing  comes  in  con- 
tact with  another,  or  with  the  centre  building,  all  the  openings  in  the 
walls,  which  extend  up  through  the  slate  roof,  have  iron  doors  in  addi- 
tion to  the  ordinary  wooden  ones,  and  which  may  be  closed  at  pleasure. 
The  floors  of  the  kitcl^en  and  bakeroom,  in  which  alone  tire  is  used,  are 
of  German  flagstone  laid  on  brick  arches,  and  all  the  stairways  in  the 
wings  are  fireproof.  It  is  intended  that  there  should  always  be  about 
twenty  thousand  gallons  of  water  in  the  tanks  in  the  dome  of  the  centre 
building,  and  fifteen  thousand  gallons  per  hour  may  be  placed  there  by 
the  pumping  engines.  A  standpipe  connected  with  this  reservoir  j^asses 
into  every  story  and  into  every  ward,  in  all  of  w^hich  it  is  intended  to 
have  a  piece  of  hempen  hose  constantly  attached,  so  that  by  simply 
turning  a  stopcock  water  may  be  put  on  a  fire  almost  as  soon  as  discov- 
ered. A  steam  pipe  also  passes  up  into  the  attic  of  each  wing,  and  as 
one  of  the  large  boilers  is  constantly  fired  up,  steam  may  at  any  moment 
be  let  into  the  building  by  simply  turning  a  valve  in  the  cellar.  Hose  is 
also  kept  near  the  steam  pumps,  so  that  it  may  be  promptly  attached 
and  water  thrown  on  the  barn,  carpenter  shop,  engine  house,  and 
contiguous  parts  of  the  hospital.  A  watchman  is  constantly  passing 
through  the  house  at  night,  and  by  means  of  two  of  Harris'  watch- 
clocks,  as  made  by  H.  B.  Ames  of  JSTew  York,  there  is  no  difficulty  in 
ascertaining  not  only  how  often  each  ward  is  visited,  but  almost  the 
moment  the  visit  was  made,  and  of  course  the  time  taken  in  passing 
from  one  ward  to  another. 

LAUNDRY   ARRANGEMENTS. 

The  clothing,  bedding,  etc.,  collected  in  the  different  wards,  after  being 
sent  to  the  cellar,  are  conveyed  from  that  point  by  the  railroad  to  the 
room  for  assorting  clothes  in  the  engine  house,  and  thence  into  the  largo 
wash  room,  in  which,  besides  the  usual  washing,  rinsing,  and  blue  tubs 

43 


338 

and  soap  vat,  is  one  of  the  valuable  Shaker  washing  machines,  in  which 
six  different  kinds  of  clothes  can  be  washed  at  the  same  time,  and  a  cen- 
trifugal wringer,  both  of  which  are  driven  by  one  of  the  steam  engines. 
From  the  wringer  the  washed  articles  are  taken  to  the  drying  closet,  in 
which  by  means  of  the  heat  derived  from*  the  exhaust  steam  from  the 
engines  passing  through  a  large  amount  of  cast  iron  pipe,  and  fresh  air 
from  the  fan,  they  are  in  a  very  few  minutes  made  ready  for  the  mangle 
(also  driven  by  steam  power),  or  folded  and  taken  by  the  railroad  to  the 
ironing  room  near  the  centre  building,  to  which  they  are  raised  by  the 
dumb  waiter  alread}^  referred  to,  or  are  sent  directly  to  the  principal 
clothes  room,  from  which  they  are  distributed  by  the  same  route  as  they 
may  be  required  in  the  wards.  All  the  divisions  of  the  washing  machine, 
of  the  rinsing  and  washing  tubs,  have  hot  and  cold  water  and  steam 
introduced  directly  into  them,  and  the  water  from  them  all  is  carried  otf 
under  the  stone  floor  of  the  room  to  one  of  the  iron  columns  below, 
through  which  it  passes  into  the  culvert  on  the  outsi-de  of  the  building. 

PLEASURE  GROUNDS,  GARDENS,  AND  YARDS. 

This  new  hospital  is  situated  in  the  midst  of  its  pleasure  grounds, 
embracing  about  fifty  acres,  and  from  most  parts  of  which  are  fine  views 
of  the  surrounding  country;  the  boundary  wall  being  so  arranged,  from 
the  natural  character  of  the  ground,  or  made  so  by  excavations,  that 
little  of  it  can  be  seen  from  any  part  of  the  building  that  is  occupied  by 
patients.  There  are  two  pleasant  grovps  of  natural  forest  trees  v/ithin 
the  inclosure,  and  several  hundred  others,  evergreen  and  deciduous,  that 
have  already  been  planted  or  collected  for  the  ^purpose,  will  give  an 
ample  amount  of  shaded  drives  and  walks.  A  carriage  road  has  already 
been  made  on  the  inside  of  the  wall  throughout  its  extent,  and  winding 
by  the  gardens  and  terraces  around  the  buildings  will  ultimately  be  two 
miles  long.  The  foot  walks  are  not  to  be  less  extensive,  and  the  brick 
pavements  about  the  building  have  been  already  mentioned.  There  are 
also,  as  may  be  remembered,  three  pleasant  yards  on  each  side  of  the 
building,  and  connected  directly  with  the  adjacent  wards.  The  vegeta- 
ble garden  will  contain  about  eight  acres,  and  is  in  full  view  from  the 
north  side  of  the  building.  Flower  borders  have  been  made  near  to  and 
around  the  entire  structure.  The  only  fences  inside  of  the  inclosure  are 
to  give  privacy  to  the  patients  in  the  yards,  or  to  prevent  those  walking 
about  the  grounds  from  approaching  certain  parts  of  the  building. 

COST. 

Without  a  statement  of  the  cost,  no  account  of  such  a  building  and 
such  arrangements  as  have  been  described  would  be  at  all  complete,  and 
especially  not  of  one  like  that  under  notice,  which  is  entirely  the  offspring 
of  the  benevolence  and  liberality  of  a  community,  a  result  of  practical 
Christianity,  and  a  generous  recognition  of  the  paramount  claims  which 
such  afliictions  of  our  fellow  men  have  at  all  times  upon  our  interests 
and  our  sympathies.  The  style  of  architecture  is  plain,  and  all  useless 
ornament  has  been  studiously  dispensed  with;  but  whenever  the  comfort 
and  welfare  of  the  patient  were  concerned,  everything  has  been  done  in 
a  thorough  manner. 

The  amount  of  money  paid  on  account  of  the  new  building  and  its 
varied  fixtures  and  arrangements,  up  to  the  present  time,  is  three  hun- 
dred and  twenty-two  thousand  five  hundred  and  forty-two  dollars  and 


339 

eighty-six  cents,  and  a  further  sum  of  about  thirty  thousand  dollars  will 
be  required  to  meet  the  other  liabilities  that  have  been  incurred.  Of 
this  total  sum,  twenty  thousand  two  hundred  and  seventy-six  dollars  and 
twenty-eight  cents  have  been  for  the  boundary  wall  and  gate  house; 
two  thousand  two  hundred  and  forty-one  dollars  and  forty-six  cents  for 
the  carriage  house  and  stabling;  eight  hundred  dollars  for  the  carpenter 
shop;  four  thousand  four  hundred  and  tifty-six  dollars  and  three  cents 
for  machinery  of  different  kinds;  twenty-three  thousand  six  hundred  and 
twelve  dollars  and  thirty-seven  cents  for  heating  and  ventilating  appa- 
ratus; fifteen  thousand  two  hundred  and  one  dollars  and  forty-seven 
cents  for  grading,  for  building,  planting,  and  improving  the  grounds; 
and  ten  thousand  four  hundred  and  forty-one  dollars  and  seventy-three 
cents  for  furniture. 


PLANS,    DESCEIPTIONS  AND   ESTIMATES    OF    THE    BOSTON 
HOSPITAL  FOE  THE  INSANE  AT  WINTHEOP. 

Boston  Lunatic  Hospital,  .        \ 

Boston  (Mass.),  September  28,  1867.  j 

To  the  Board  of  Directors  for  Public  Institutions: 

Gentlemen:  Three  months  ago  the  committee  on  the  proposed  new 
''Hosj^ital  for  the  Insane  "  referred  the  '-j^lans"  to  the  architect  (N.  J. 
Bradlee,  Esq.)  and  myself,  with  the  request  that  we  would  give  them  a 
thorough  revision.     That  has  been  done  and  the  result  is  before  you. 

While  not  doubting  that  experts  of  larger  experience  niixy  discover 
defects  and  suggest  improvements,  we  are  at  a  loss  to  see  how,  without 
great  expense,  the  plans  can  easily  be  materially  improved. 

Such  a  hospital  structure,  containing  no   provision  that  can  well  be 
dispensed  with,  and  requiring  not  a  dollar  for  mere  ornamentation,  will 
be  no  discredit  to  the  humanity,  intelligence,  and  good  taste  of  Boston. 
These  j^lans  have  my  hearty  and  unqualified  approval. 
Yery  respectfully, 

CLEMENT  A.  WALKEE, 

Superintendent. 


construction  of  the  building. 

The  exterior  walls  will  be  of  brick,  with  granite  trimmings,  sur- 
mounted by  a  brick  cornice  and  French  roof. 

The  grouping  of  the  several  wings,  falling  back  as  they  do  from  the 
centre  and  from  each  other,  with  their  several  projections  and  bays,  will 
give  a  very  pleasing  effect  to  the  whole. 

basement. 

This  story,  which  will  be  from  four  to  six  feet  above  the  level  of  the 
ground,  will  contain  five  hundred  and  four  hot  air  chambers,  each  being 
two  feet  by  five  feet,  for  the  pipes  to  heat  the  building.     The  basement 


340 

of  the  rear  centre  building  will  contain  store   rooms   and   vegetable 
cellars.  • 

PRINCIPAL   STORY. 

The  general  plan  of  the  building  consists  of  a  centre  building,  three 
stories  high,  sixty  feet  by  ninet^^-two  feet,  a  building  in  the  rear  of  the 
centre,  two  stories  high,  forty-nine  feet  by  one  hundred  and  fifty-six 
feet,  and  two  wings  of  three  sections  each,  two  being  three  stories  high. 
The  first  section  on  each  side  is  fifty-six  feet  by  one  hundred  and  fifty- 
four  feet;  the  second  section,  fifty-six  by  one  hundred  and  forty-five  feet 
nine  inches;  the  third  section,  two  stories  high,  fifty-seven  feet  by  one 
hundred  and  twenty-one  feet  nine  inches;  one  being  at  each  side  of  and 
at  an  angle  of  forty-five  degrees  to  the  second  section.  This  gives  eight 
distinct  wards  for  each  sex,  the  ininimum  required  (by  unanimous  vote 
of  the  Association  of  Medical  Superintendents  of  American  Institutions 
for  the  Insane)  in  a  hospital  for  two  hundred  patients;  this  designed  for 
three  hundred. 

The  principal  story  of  the  centre  building  contains  Superintendent's 
room,  twenty  feet  square;  private  room,  seventeen  feet  by  twenty  feet; 
Assistant  Superintendent's  room,  seventeen  feet  by  twenty  feet;  apoth- 
ecary's room,  twelve  feet  by  seventeen  feet;  library,  twelve  feet  by 
seventeen  feet;  dining  room,  twenty  feet  by  forty  feet;  pantry,  seven- 
teen feet  by  twenty  feet;  and  six  large  closets. 

The  rear  centre  building  will  contain:  reception  rooms,  twelve  feet  by 
eighteen  feet;  attendants'  dining  room,  eighteen  feet  by  forty  feet;  store 
room,  eighteen  feet  by  twenty-six  feet;  kitchen,  twenty  feet  by  forty- 
two  feet;  laundry,  twenty  feet  by  forty  feet;  ironing  room,  twenty-two 
feet  square;  pantry,  six  feet  by  fifteen  feet;  bakery,  fourteen  feet  square; 
bread  closet,  seven  feet  by  twenty -three  feet;  tin  closet,  six  feet  by 
fifteen  feet;  oven,  ten  feet  by  twelve  feet;  drying  room,  ten  feet  by  eigh- 
teen feet. 

The  first  section  on  each  side  of  the  centre  will  contain  fifteen  single 
rooms,  eight  feet  six  inches  by  fourteen  feet;  sitting  room,  twenty -two 
feet  by  thirty  feet;  bay  window,  eighteen  feet  by  twenty  feet;  reception 
room,  thirteen  feet  by  twenty-one  feet;  attendants'  room,  thirteen  feet 
by  twenty-one  feet;  bath  room,  nine  feet  by  fourteen  feet;  storeroom, 
nine  feet  by  fourteen  feet;  dormitory,  seventeen  feet  by  twenty-seven 
feet;  dining  room,  sixteen  ieet  by  thirty-four  feet. 

The  second  section  on  each  side  will  contain  sixteen  single  rooms; 
general  store  room,  twenty  feet  by  twenty-three  feet;  the  other  rooms 
are  the  same  as  described  for  first  section. 

The  third  section  will  contain  twelve  single  rooms,  eight  feet  six 
inches  by  fourteen  feet;  open  corridor,  twenty-eight  feet  by  sixty -two 
feet;  dining  room,  seventeen  feet  by  twenty  feet;  storeroom,  ten  feet  by 
seventeen  feet;  attendants'  room,  fourteen  feet  by  seventeen  feet;  bath 
room,  ten  feet  by  seventeen  feet. 

SECOND   STORY. 

The  second  and  third  stories  of  the  first  and  second  sections  are 
divided  the  same  as  the  first  story  of  said  buildings,  and  the  second 
story  of  the  third  section  is  also  like  the  first  story  of  the  same.  The 
attics  of  the  first  and  second  sections  will  furnish  pleasant  and  desirable 
infirmaries.  The  attics  of  the  third  section  will  aff'ord  ample  and  con- 
venient room  for  the  isolation  of  small  pox  and  other  contagious  diseases. 


341 

The  second  and  third  stories  of  the  centre  building  are  arranged  to 
accommodate  the  Superintendent  and  his  family,  with  his  assistants. 

The  second  story  of  the  rear  centre  building  contains  a  chapel,  forty-five 
feet  by  seventy-five  feet;  domestics'  room,  fourteen  feet  by  twenty  feet; 
billiard  room,  eighteen  feet  by  forty -five  feet;  storeroom,  twelve  feet  by 
twenty  feet.  The  main  centre  building  and  the  first  section  on  each 
side,  also  rear  centre  buildings,  are  connected  by  corridors  ten  feet  wide. 

THE    ENGINE    HOUSE 

Is  located  one  hundred  and  three  feet  distant  from  the  rear  centre 
building,  and  is  forty-seven  feet  by  seventy-four  feet,  containing  a  boiler 
room  thirteen  feet  by  fifty-seven  feet;  engine  room,  fourteen  feet  by 
twenty-four  feet;  fan  blower  room,  thirty-two  feet  by  fourteen  feet; 
fuel  rooms,  fourteen  feet  by  twenty -three  feet,  and  fourteen  feet  by 
thirty-four  feet;  connected  with  this  house  is  the  large  chimney,  fifteen 
feet  square  at  the  base  by  one  hundred  and  eighty  feet  in  height. 

CONSTRUCTION. 

The  outside  cellar  walls  are  to  be  two  feet  thick  of  stone  laid  in 
cement  mortar;  the  wails  above  are  of  brick  twenty  inches  thick,  laid 
hollow,  the  outer  walls  being  twelve  inches,  an  air  sj^ace  of  four  inches, 
and  the  inner  wall  four  inches  thick.  The  interior  walls  on  the  side 
corridors  will  be  also  twenty  inches  thick,  so  as  to  leave  room  for  the 
ventilating  and  heating  flues  to  pass  through  them.  To  render  the 
building  as  nearly  firei:)roof  as  possible  without  going  to  the  expense  of 
brick  arches  and  iron  beams  or  girders,  all  the  plastering  will  be  done 
directl}^  upon  the  brick  walls  without  furring;  the  floors  will  be  plas- 
tered between  the  floor  boards  and  the  base  or  plinth  around  the  rooms, 
and  corridors  will  be  of  face  brick,  painted;  all  the  inside  partitions 
will  be  also  of  brick. 

To  give  some  idea  of  the  size  of  the  building,  it  may  be  stated  that  it 
will  require  one  thousand  seven  hundred  and  seventy-five  perches  of 
stone  for  the  foundation.  Seven  million  seven  hundred  and  fifty  thou- 
sand two  hundred  and  fifty  bricks  will  be  used  in  the  walls;  sixty-two 
thousand  eight  hundred  and  twenty-nine  yards  of  plastering;  three 
thousand  two  hundred  and  twenty-four  feet  of  gutters,  with  two  thou- 
sand twenty-two  feet  of  conductors;  eighteen  thousand  two  hundred 
and  fifty  feet  of  gas  pipe;  one  million  two  hundred  and  eighty-nine 
thousand  four  hundred  and  eighty-eight  feet  of  lumber;  one  thousand 
two  hundred  and  thirty-eight  windows;  fifty-nine  thousand  four  hundred 
and  twenty-four  lights  of  glass,  and  nine  hundred  eighty-nine  doors; 
five  hundred  and  four  being  required  for  the  pipe  chambers  in  the  base- 
ment. 

HEATING   AND    VENTILATION. 

The  building  will  be  arranged  so  as  to  hereafter  decide  upon  the  best 
method  of  heating,  whether  by  hot  water,  high  or  low  pressure  steam, 
all  of  which  systems  have  their  strenuous  advocates.  The  ventilation 
of  all  the  waterclosets  will  be  effected  by  the  downward  draft  to  the 
heated  chimney;  the  ventilation  of  the  wards  will  be  likewise  arranged 
for  the  downward  draft;  there  will  also  be  j^rovided  in  the  boiler  house, 
a  fan  blower  upon  the  Doctor  Nichols  plan,  to  be  used  as  occasion  may 
require. 


,342 

The  high  chimney  will  be  so  constructed  as  to  form  a  large  ventilating 
flue  entirely  around  the  boiler  flue,  to  assure  a  steady  draft.  The  under- 
ground air  flues  will  be  eight  feet  in  diameter,  diminishing  in  size  as 
they  approach  the  third  section,  with  small  branches  to  each  of  the 
several  hot  air  chambers  in  the  basement  story. 


COimTY    OF   SLTEPtEY   ADDITIO:NrAL   LUNATIC   ASYLUM. 

At  Brookwood,  near  Woking. 

The  additional  asylum  for  the  pauper  lunatics  of  the  County  of  Surrey 
is  designed  to  accommodate  six  hundred  and  fifty  patients,  and  stands 
on  an  estate  of  about  one  hundred  and  fifty  acres  in  extent,  at  Brook- 
wood,  about  three  miles  from  the  Woking  station  on  the  South  Western 
E  ail  way. 

The  site  is  bounded  on  the  south  by  the  Basingstoke  Canal,  and  on  the 
east  and  west  by  the  high  roads  to  Guildford  and  Chertsey.  Few  sites 
could  be  found  in  the  country  better  adapted  for  such  an  institution. 
The  soil,  a  primary  consideration,  is  a  dry  sand,  with  occasional  veins  of 
gravel,  loam,  and  clay.  The  ground  rises  gradually  from  the  south  and 
west  about  seventy  feet  above  the  level  of  the  canal,  and  the  buildings 
are  erected  on  a  plateau  of  some  extent,  with  a  fine  range  of  views  and 
southern  aspect. 

The  plan  of  the  building  gives  to  every  part  uninterrupted  views  of 
the  surrounding  country,  and  free  access  to  light  and  air. 

The  principal  entrance  with  the  visiting  Justices',  Superintendent's, 
Porter's,  Steward's,  and  waiting  rooms  form  the  central  portion  of  the 
north  front  of  the  main  building. 

To  the  west  of  the  entrance  block  is  the  laundry  wing,  with  the  rooms 
for  the  female  working  jDatients  and  their  attendants. 

On  the  east  side  oi  the  entrance  block  corresponding  to  the  laundry 
wing  just  described,  are  the  workshoj^s  and  the  apartments  appropriated 
to  the  patients  engaged  in  them. 

In  the  centre  are  placed  the  kitchen,  offices  and  stores,  so  arranged 
that  the  service  on  the  male  side  is  perfectly  separated  from  the  female 
side. 

The  apartments  for  the  Assistant  Surgeon  and  the  matron,  vv^ith  dis- 
pensary and  stores,  are  grouped  together  in  the  centre  of  the  south 
building,  near  the  wards  for  recent  cases,  which  with  the  infirmaries 
form  the  rest  of  the  south  front  of  main  building. 

The  height  of  the  rooms  occupied  by  the  patients  on  the  ground  floor 
is  twelve  feet,  and  on  the  upper  floors  eleven  feet. 

^  Fifty  superficial  feet,  or  nearly  six  hundred  cubic  feet,  are  allowed  to 
each  patient  in  all  dormitories,  except  those  in  the  infirmaries,  where  the 
cubical  contents  exceed  seven  hundred  feet  per  patient. 

The  smallest  separate  sleeping  room  is  nine  feet  by  seven  feet,  which 
gives  seven  hundred  cubic  feet;  in  the  infirmaries  they  vary  from  eleven 
feet  by  eight  feet  seven  inches  to  fourteen  feet  by  ten  feet. 

The  day  rooms,  except  one  on  each  side  of  the  wards  for  recent  and 
acute  case,  are  all  on  the  ground  floor. 


343 

Lavatories,  water  closets,  baths,  slop  rooms,  store  rooms,  and  closets 
are  provided  iu  all  the  wards. 

To  the  east  and  west  of  the  main  building  are  placed  detached  blocks 
with  associated  day  rooms  and  dormitories  for  the  accommodation  of 
ninety  patients  in  each  building.  These  blocks  are  connected  with  the 
main  building  by  covered  passages. 

The  buildings  are  constructed  in  stock  brickwork,  relieved  with  a  few 
coloured  brick  dressings  and  sailing  courses. 

The  stairs  are  of  stone  in  all  parts  occupied  by  the  patients,  with  the 
well  holes  built  up. 

The  floors  of  all  day  and  slee])ing  rooms  and  of  the  south  corridors 
and  corridors  in  infirmary  wings  are  boarded. 

The  sashes  generally  are  of  wood,  double  hung  with  locks  and  keys, 
to  prevent  their  being  opened  beyond  a  certain  height. 

The  doors  to  all  patients'  rooms  have  solid  panels,  and  all  angles  are 
rounded. 

The  day  rooms  and  corridors  have  open  fireplaces,  in  which  are  warm 
air  grates,  so  constructed  that  warm  air  is  admitted  either  into  the  room 
wdth  the  fireplace,  or  conducted  to  the  chamber  above.  Provision  has 
been  made  for  the  introduction  of  warm  water  pipes  in  case  any  auxiliary 
heating  power  should  be  required. 

In  both  day  rooms  and  dormitories  ventilating  Aujcs  for  the  extraction 
of  foul  air  are  formed,  having  sectional  areas,  in  proportion  to  the  sizes 
of  the  rooms,  connected  wath  the  towers  by  large  air  shafts  formed  in 
the  roofs. 

The  sew^age  is  conveyed  from  water  closets,  sinks,  etc.,  by  means  of 
pipe  drains  to  filtering  tanks,  so  placed  and  constructed  as  to  permit  of 
the  distribution  by  gravity  of  the  filtered  water  over  a  considerable  por- 
tion of  the  land  under  cultivation. 

The  Superintendent's  house  is  a  dctatched  building  placed  to  the 
southwest  of  the  main  building,  near  the  boundary  of  the  airing,  grounds 
for  the  female  patients.  Plans  of  the  floors  of  this  house  are  given,  and 
show  with  sufiicient  clearness  the  arrangement  and  accommodation 
provided. 

The  house  for  the  gardener,  in  which  accommodation  has  been  pro- 
vided for  twelve  of  the  more  quiet  patients,  is  situated  in  the  east  of  the 
main  building,  about  tw^o  hundred  yards  from  the  entrance  to  male 
airing  grounds,  and  near  the  kitchen  garden. 

The  farm  baililf  s  house,  in  which  accommodation  has  alsO'  been  pro- 
vided for  tw^elve  patients,  adjoins  the  farm  buildings. 

The  gas  works  are  placed  to  the  northwest  of  the  main  building  about 
sixty-five  yards  from  the  laundry  block. 

The  chapel  is  a  detached  building,  designed  to  accommodate  three 
hundred  and  forty-three  persons,  very  simply  constructed,,  with  plain 
gothic  headed  windows  and  doors.  Ventilating  dormers  are  provided  in 
the  roof,  and  the  building  is  heated  by  Haden  &  Son's  apparatus.  There 
is  a  chancel  with  vestry  to  the  north.  From  the  entrance  of  main  build- 
ing to  the  south  porch  of  chapel  the  distance  is  about  two  hundred 
yards. 

The  detailed  statement  of  the  accommodation  provided  for  the  patients 
in  the  several  parts  of  the  building  is  as  foUow^s,  namely: 

RECENT    CASES. 

Female  side — Ground  floor:  Single  rooms,  eight.     First  floor:  Single 


344 


rooms,  eight;    dormitories,  twelve.      Second   floor:  Dormitories,   forty- 
five.     Total,  seventy-three. 

Male  side — Ground  floor:  Single  rooms,  eight.  First  floor:  Single 
rooms,  eight;  dormitories,  twelve.  Second  floor:  Dormitories,  forty- 
five.     Total,  seventy-three. 


INFIRMARY. 


Female  side — Ground  floor:  Dormitory,  six;  single  rooms,  three. 
First  floor:  Dormitories,  twenty-four;  single  rooms,  four.  Second  floor: 
Dormitories,  thirty-four.     Total,  seventy-one. 

Male  side — Ground  floor:  Dormitory,  six;  single  rooms,  three.  First 
floor:  Dormitories,  twenty-four;  single  rooms,  four.  Second  floor:  Dor- 
mitories, thirty -four.     Total,  seventy-one. 


SOUTH    FRONT. 


Female  side — Second  floor:  Dormitories,  thirty-two. 
Male  side — Second  floor:  Dormitories,  twenty -two. 

NORTH    FRONT. 

Female  side — First  floor:  Dormitories,  twenty-five.  Second  floor: 
Dormitories,  twent}^     Total,  forty-five. 

Male  side— First  floor:  Dormitories,  five.  Second  floor:  Dormitories, 
eighteen.     Total,  twenty-three. 

LAUNDRY   BLOCK. 

First  floor:  Dormitories,  sixteen;  single  rooms,  two.     Total,  eighteen. 

WORKSHOP    BLOCK. 

First  floor:  Dormitories,  sixteen;  single  rooms,  two.     Total,  eighteen. 

DETACHED    BLOCKS. 


FEMALE    SIDE. 

MALE     SIDE. 

Ground  Floor. 
Dormitories  

20 
2 

68 

Ground  Floor. 
Dormitories 

20 

Single  rooms 

Single  rooms    ... 

2 

First  Floor. 
Dormitories  

First  Floor. 
Dormitories 

r>8 

Total 

Total 

90 

90 

licceiit  cases.... 

Infirmary  

Soiitb  front 

North  front.... 
Laundry  block. 
Detached  block 

Total  


3 

SUMMARY 

45 

OK    TOTALS. 

Kccent  eases 

1 

73 
71 
32 
45 

73 

Infirmary  

South  front 

71 

22 

North  front 

23 

18 
90 

Workshop  block 

Detached  block 

IS 

.  .             18 

Bailifi"s  house 

Gardener's  house 

12 
12 

j 

Total  

329 

321 

The  buildings,  with  all  the  necessary  work  and  fittings  having  been 
completed,  the  institution  was  opened  in  the  Summer  of  eighteen  hundred 
and  f?ixty-seven. 

The  cost  of  the  buildings,  exclusive  of  fittings,  and  engineers  and 
ga§  works,  amounted  to  the  sum  of  sixty-one  tliousand  nine  hundred 
pounds  sterling. 

C.  H.  HOWELL.  Architect. 


44 


EKRATA. 

.Page  thirteen,  tentli  line  from  bottom,  for  '"eleven  "  read  "seven." 
Page  fort^^-seven,  nineteenth  line  from  hottom,  for  "excess  "  read  "sexe?." 
Page  iifty,  fifth  line  of  second  paragraph,  for  "  courses  "  read  "  causes." 
Page  eighty-eiglit,  ninth  line  from  top,  for  "  seventeenth  "  read  "nineteenth." 
The  tables  of  "  Results  of  Treatment,"  on  pages  two  hundred  and  live,  two  hundred  and 

six,  and  two  hundred  and  seven,  should  come  immediately  after  "Results  of  Treatment," 

.  »n  pagi^  two  hundred  and  two. 

Page  sixty-four,  Mrst  column  ligures.  fifth  line,  for  "260,247"  read  "560,247." 


m  mQMm^ 


Appendix   F.-  PI.    1 


WARD    BUILOiNC 

SO.     Hot  Air  Chambers.      |  31 

32.     Serving  Roo 


Nath't  J.  Bradlee,  . 


CENTRE    8UILD1NQS 


H'tll. 

rwridor 

Sitting  Rooms. 

Store-Roovis 

Pantry. 

Kitchen. 


Laundri). 
Drying  Room. 
Railroad. 
Serving  Room- 
Workshop. 
CMar. 


35.     Medical  Stores 


BASEMENT 

m 


Appendix   K.-  I'l. 


•<sm 


l_j'^^-^<>^^'^'tz;|>t^ 4^'^-' 


l't?rniVr-t!./i'i:iJ  SlM 

m 


-\pi>(Mi(lix    p.  — PI 


WA 

1.  J  tall. 

2.  CorrUlnr. 

«.  Bay  Windoii-. 

4.  Sitting- Room. 

f>.  Heccption  Room 

fi.  .Ut''/id'a)itx'  Rooi 


CEN 

TRE     BUILDINGS. 

1. 

HaJL 

1     Ki.     Libyan/. 

2. 

6'o?-rirf(>r. 

1     17.     Pantry. 

S. 

Jieception  Room 

1     IS.     Kitc/ieti. 

7. 

IHuiny  Room. 

]<>.     Bakcrv. 

10. 

Store- J:«om. 

20.     tf/-ertc/  C7o.5ef. 

12. 

Mater-  Clo.sft. 

I'l.     J'in  Closet. 

i;j. 

Svpf.-^   Ro,;,,. 

22.     Ove/i. 

u. 

Ass't  Snpft:  Roi 

Hi. 

2.-;.     Laundry. 

J  5. 

Apothecary's. 

24.     Tro7iing  Rnom 

•Ih. 

Dry; 

>fl  Hoo'ii. 

FIRST     STORY. 


kppi-ii'lix   I-'.— PI. 


xxV 


<^  V 


^1 


"  ^' ' ' "  ''"■■'"'« 


Appendix  F.— PI.  3- 


^  J  jKgSIrTTTXIJTTTXg^fj 


FOR  THE   INSANE. 


PUT — f  T-™ Ttrn 
I 


1i     : 

m     i 

.JfoiiniI>iniEti 


ill  F^  fir 


FhAhT  OF  THE   r'KNNKYlLVANlA    miSiriTAIi,   FOH.  TME  IINHANE. 


Appendix  FPi.  ^, 


TTTTT1 

m 


(NriMARY^OR     FEM/ALES. 

"i'iiim[_«' 


.RCS        fOR      FEIVdALE        PATIENTS. 


ULAMAZOO. 


Appendix  F.  Pi.  -^ 


'^'^^^^SfMOTlfefS 


^^^.IWI] 


pTTTTTl 


im     [TTTTn 


MICHIGAN  ASYLUM    FOR    THE  INSANE,  KALAMAZOO. 


Al'.V-PI...^ 


< 


(;KOrXl)    PLAN. 


PL, 7 


yxy.^.>ixi(^  ^' 


COlNrV   Ol     SlKIiKY 

m:w  rorATY  lixai  u  asym  m 


J 


S.ali-  Ktr.rl  I..  |Ih-1ii^ 


A-^M^' 


f>S$-/^ 


'i^'!^^/  /- 


a 


/ 


...^  m  U : 


f^^p^ 


^-■a 


rrx; 


/ 


/ 


PLAN   1)1     1   IHSI     1  l,()()M 


CH)l  T» 


CX)I  XT 


AP.F-  PL.T 


Scale 


1 


, 

AP.  1    - 

1'I..7 

COl'XTV  OF    .sriiUKV 

XKW  (X)rXTY  U  XATK^  ASVU'M  . 

S(-;«l<>    lO  1<M>I  H)  Ihc  Iiic  h 

' 

I 


V'^ 


T-.r--'  V 


I     "iT=7.°ri 


tiir  — "  1 — 


■^ 


,.C..,0„.| 


IM  AN  or  SKCOM)  I'l.OOH 


AP.  IWh.H. 

Ht  AHOIT  X  77.700 


y 


A(:(  ((ALMOHAIKS  .iHo  PAl'l'lOK    PATIKMS 


Day  Roomp. 
Altendiim's  Rooms. 


DreBsing  Rooms. 
Sculleries. 


Central  Public  Booms. 

Medical  Soperiatendeofi!  Room. 

Kotrnnce  lo  Med.  Siiperinteudent's  HouBe. 

'S'iBUing  Room. 

Porter's  Room. 

Entrance  to  .Assistant  Med.  Officer's  Roonn. 

Chaplain's  Room  and  Library. 

Committee  Room. 

Do.       Retiring  Room. 

Department,  Officers,  etc. 


V 


St™ t      J 


§ 


Aiv  1- .  rr.s. 

COST  AIM)  IT   X  77.70  0 


Detached  Buildings  and  Tard. 


B .     Steward's  Honse. 

C  .     Housekeeper's  Rooms  k  Rooms  for  Domestic  SetT^ne. 
0  .     Lanadry  Block  with  Ward  attached, 
a  .  Sorting  and  Receiring  Room. 
b .  Washing  Hoase. 
C  .      Do.       for  Fool  Linen, 
d.  Drying  Ground. 
6  .  Drying  Clo.=et. 
f  .  Ironiug  Room. 
£  .     Workshop  Block  with  Ward  atfRohed. 
a.a  .   Tailor  a  aod  Sboemaker'ff, 
b.b .  Maitress  Makers. 
C.C  .  CarpcDter'a. 
d.d .  Painter's. 
e.e  .  Y&rd  for  Workshops. 
F.    Engiaeer's  Yard,  including  Engine  Honse. 
Plumber's  and  Smith's  Shops.  Gasworks. 
Steam  and  Hot  Water  Boilers,  Steam  Engine  and  Well. 
Stable  Yard  wiih  Shod. 

Do.     Med. ! 
Cliurch. 

Entrance  Lodge. 
Female  Airing  Court! 
Male  Airing  Courts. 
Kitchen  Ganlen. 


PLAN   OF   FIRST  FLOOR 

OCCUPIED   ENTIRELY    BY    SLEEPINQ    ACCOMMODATION    AND   THE    NECESSARY    CLOTHES    STORES.    LAVATORIES.    ETC..    ETC 


Reference 

I*.  Dormitories. 

2.  Sinffle  Rooms. 

3.  Attendantt. 

4.  StOTM. 

5.  Bath. 

7.  Lavatories. 

10.  Head  Attendant's  Rooms. 

(6.  Assistant  Medical  Officer's  Room/. 

A.  Medical  Superintendent*!  House. 

B.  Sieward^s  JJousp.. 

C.  Houaekeeper  and  Domtttic  Servants 
F.  Engineer's  Bouse. 


[inn 


[^feai^LFg-fe^;^ 


-t 


Soa/e  of  f'ff/. 


AF.  F  -  I'L.ll 


^ 


LIWATU^  ASYLl  >r. 

MKKHKNUKIU;.    XKAU  lIAAltl.KM 
(.lioiiml  Plan  and  Klovation. 


B 


Ar.  I-  -  I'L.ii 


;3^j-T^T:Trrr-^?"rHP^fE['f?T-|-7r-:-T-yT±Tj 

r-TTl'-—^—-'- •'—".-'•" — -;—- -r+-t-r-'-L-J--J--i  — -U---X-  +  4-r;Tn 

b±t+^-\--'—- '"Id tar  r"' p=i 


^^M 


E 


11-^ 

I  ^s 


, , !  I l._L!IIIhK--iIifflio;ii--ni£I!l 


rK 


'  br^  1-1-4  ^ 


7?  L  _L  j_  _i.  1 — I 


T:n 


_  J.  J.  —  J 


lULCLJLnj]  n  n  n  J,  n  n  i 


1 


1. ^^r^-r-T-iT , ■■  ■■ :  ■  ,^  ;  :  i     ill  n  n  n  n  n_n,n7nrff  ninilMfl.D.iiiinii-r'' 


C  ASYLLl 

IG,   NKAR  HAA 


ri-'    :  '— 


.U*.F.  PL.l^ 


LUNATIC    ASYLUM. 

MKEllENUKKi;.    NKAR  HAAHI.KM  . 
Plan  of  iho  Hrsl  Slor\: 


.U».F.  PL.  12. 


fiw:r 


AP.  1\  VVAll. 


Officer's  Buildings, 


lirA'ATK     ASYH'M    IX   A'IKXNA. 


M   1 


^nwvwwwww^vwwwviX^ 


nr 


[e^.Tin.-Erji!i;aj 


Female  Dmsions, 


>„< 


Bath  Roomst  Tor  let  a 


Bedroom  for  3d  CIuss  Pali 
Harloi-  ami  Dining  Rnoine 
Bedroom  for  3d  Cla«8  I'alii 


Economic  Department. 


ninnn 


>  ti 

_  T     I — i 

n 


\}\  V  PI.  i;i. 


Officer's  Buildings. 


d  fiath  Room  fur  Ut  and  'i 

e  First  Steward's  Room 

/  Kitchen  for  WaTming  W 

•J  Pasteboard  and  Straw  W 

k  Billiards  and  Dining  Kooni^ 

Paper  banger  SUop 
Cabinet  Maker  and  Tumet  Shop 
,  Bedroom  for  M  Class  Patients 


^^il  1,^., 


Ss^ 


(..ii.U'ii 


'E 


r— m^. 


j^-^ — lE-^L. 


t^: 


U-L  iti^i  t?^        SSI.:!  ^i--da 


HW.~   ,  u'r^i  |t- 


j4'jx\.u:ou 


T 1T-T— V*-     ^ 


^^  r^CFt 


ZLT 


GENERAL   PLAN. 

M''II  SOIIIEK,  SupcriiilPiident, 
l)o(  loi  I'OHKT,  Mpdical  Direclnr. 


Descrixrlion  of  Plan 

ftnlml  'Utiildiitq  Ibrt/cui'itil  Vsc . 


Tr--J^i 


*^-  L-rl. 


'/    G 


leth,-  mehc  l.iO.mV) 


.  ](alf  Side 

2  Chiipi-I. 

'A  Sitf)nt'nft1fntUtits  'JitiittlOnf. 

.'»   .  liittrtitiitttsoi' the Stntvnt. 
8    Wmiiiams,-. 

3  BnlUHaus, 

10  'HiiiMiiul  Ihr  llif  i/iiirt'lUlunt!: 

11  'Jinitifniil  lorllii  luilf'tfliiff. 
\i  Clhlhrl/i,  i.whiU. 

lilnlilm.in- 

U)  W///«/.  iii/,'/i.<!/,,iii(lniom  farlh/ .--Iwli/ 
ni:  liioloiiK/  mill  'RrtlinU'gtl . 

I'l  'Biiililliiii  (ill  the  Wirhiiiiii. 

ere 'Oniiiis to eiiiifl  anil i/istrthil/ellaler 

Jf/U'iilcrClosets. 

1/1/1/  Hiiir.l  l.eilli(iii'J)itrJl/ 


Imperia  I 


(~=^    (~ 


Hiffhtuai/. 


Ah.  6. 


==^ 


/ 


.\p.   F.— P1.    15. 


Flfft 


A 

^ \J 


F,.g.l.. 


ij 


-^x 


i.- J_!  \M^ -Hni^^-fuBi  I— it-  L__ J^ 


<'~-l.'=^ 

yp 


r-JV-fl:m«_m...^„.M  l„.jnT3™^[^ 


i^T^}^^m^  tE 


EXPLA]S"ATION     OF     TABLE  NUMBEE     TWO. 
Figure  1. 

Flan  of  situation.     Parterre  and  first  story  of  Institution. 

I.  Building  of  admiDistration.  II.  Section  of  quiet  patients.  III. 
Section  of  less  quiet  patients.  lY.  Section  of  idiotic  (unclean)  patients. 
V.  Section  of  raving  patients.  VI.  Church.  YI.  Household  building. 
YIII.  Coach  room.     IX.  Ice  cellar. 


a.  Day  room; 

b.  Kitchen  for  dishwashing; 

c.  Room  of  attendants; 

d.  Sleeping  apartment,  third  class; 

e.  Isolating  room; 
/.  Room,  first  class; 

g.  Room,  second  class; 

h.  Garderobe  room; 


i.  Depot  room ; 

k.  Room  for  somatic  patients ; 

I.  Cell; 

m.  Drying  room; 

n.  Bath  room,  third  class; 

0.  Dressing  room; 

]).  Bath  room,  first  and  sec'nd  class 

q.  Single  bath  room. 


1.  Announcing  room; 

2.  Yisiting  room; 

3.  Medical  office; 

4.  Medical  office; 

5.  Store  room  for  material; 
(3.  Room  of  the  office  porter; 

7.  Dispensary; 

8.  Room  of  the  porter; 

9.  Sleeping  room  of  the  porter; 

10.  Office  of  the  Administration; 

11.  Magazines; 

12.  Lodgings  of  Assistant  Physic'n ; 

13.  Room  of  accountant; 


14.  Sewing  room  (on  the  other  side, 

lodgings  of  kitchen  servants) ; 

15.  Kitchen  for  cooking; 

16.  Adjoining  rooms  thereof; 
16'  Formerly  provisory  kitchen; 

17.  Kitchen  for  washing; 

18.  Adjoining  rooms  thereof; 

19.  Room  for  washing  machines; 

20.  Room  for  steam  boiler; 

21.  Engine  room; 

22.  Room  of  machinists; 

23.  Ventilation  tower. 


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